To say that we will soon be able to ‘prevent diabetes in all its forms in my lifetime’, is a bold statement. Especially so since it is made by Professor Chantal Mathieu, a diabetologist.
Given that the UK is in the grip of a diabetes crisis, with more than five million people living with the dangerous blood sugar condition, a figure which is set to rise even further, it may even sound like wishful thinking.
But Prof Mathieu knows what she’s talking about. She’s President of the European Association for the Study of Diabetes – also known as EASD – an annual conference attended by thousands of world-leading researchers.
For years, it’s been a worthy if somewhat staid affair, with few major announcements being made. Now, the conference – held this year in Madrid, Spain – is arguably the most exciting medical gathering around.
Professor Chantal Mathieu, a diabetologist, says that we will soon be able to ‘prevent diabetes in all its forms in my lifetime’
A new wave of blockbuster drugs such as semaglutide and tirzepatide, known by their brand names Ozempic and Mounjaro, are creating a seismic shift in the diabetes world
That’s partly thanks to the new wave of blockbuster drugs such as semaglutide and tirzepatide – known by their brand names Ozempic and Mounjaro – which are creating a seismic shift in the diabetes world and beyond.
The injections mimic a hormone called GLP-1 which boosts the production of insulin, which regulates blood sugar and is vital to controlling type 2 diabetes – the most common form of the condition.
The technology has been around for several decades, but it was only in the past ten years that researchers realised that the drugs also suppressed appetite, making them a highly effective weight loss treatment Patients on Mounjaro can expect to lose as much as a third of their body weight – which is why experts have dubbed it the ‘King Kong’ of fat jabs.
That’s not all. Increasingly, experts believe that these GLP-1 drugs also reduce inflammation throughout the body. They are now being touted as possible treatments for heart, liver and kidney disease, cancer, Parkinson’s and even Alzheimer’s.
A growing number of researchers believe that giving these jabs to patients newly-diagnosed with type 2 diabetes could quickly reverse the condition – and potentially even cure it. This would be revolutionary.
The condition is caused by excess fat, causing the body to lose its ability to control blood sugar levels. Left untreated, it can lead to serious health problems like blindness, limb amputations and deadly heart disease.
Research has found it is possible to temporarily reverse it by going on a strict, ultra-low calorie diet. However, this is incredibly hard work for patients and only a tenth of participants were still in remission – the medical term which refers to patients having stable, healthy blood sugar levels – five years later.
Fewer than four per cent of patients who do not take part in a weight-management programme will ever enter remission. Yet, although Ozempic can bring down blood sugar levels and trigger weight-loss – both key in reversing the condition – the drug is still reserved by the NHS for only the sickest diabetes patients. At present, only patients who have failed to respond to three other diabetes drugs can take the blockbuster treatment.
Experts say giving it earlier, however, could significantly change the way the NHS treats diabetes – and change the lives of thousands. ‘Currently, by the time we start patients on these drugs, the horse may have bolted,’ says Dr Shivani Misra, a diabetes expert at Imperial College London, who believes GLP-1 drugs are being given when damage to the body has already been done.
She argues that administering the injections early could lead to ‘metabolic recovery’, meaning that the initial cause of the uncontrolled blood sugar could be fixed.
‘If we get in early with them, I think we’d be inducing recovery in most people with type 2 diabetes,’ she says. Dr Misra believes a UK trial offering GLP-1 drugs as a ‘first-line treatment in those with the highest risk type 2 diabetes’ could be a gamechanger.
But this, the Madrid conference heard, is only the start.
Across the world, scientists are making huge strides in finding innovative ways to not only treat the disease and protect patients from its most serious consequences, but also prevent it. Here are some of the standout presentations from the conference – and why they matter.
LIFESAVING HEART PILL REDUCES RISK
A highly effective tablet for heart failure and kidney disease also slashes the risk of type 2 diabetes, according to new research. The £17 daily pill, called finerenone, stops the body from producing excess amounts of a hormone that scars the kidneys and raises the risk of heart disease.
A £17 daily pill called finerenone, a highly effective in the treatment for heart failure and kidney disease, also slashes the risk of type 2 diabetes
It is already offered to type 2 diabetes patients living with kidney disease, where the crucial organ stops working, to protect them from life-threatening complications. This is because consistently raised blood sugar levels from diabetes leads to the overproduction of this hormone, called aldosterone.
New data presented in Madrid has shown that heart failure patients given finerenone saw their risk of type 2 diabetes cut by nearly a quarter, compared to patients taking a placebo.
Heart failure affects nearly one million Britons and occurs when the heart becomes too weak or stiff and is unable to pump blood effectively around the body.
While there have been major treatment advances in recent decades, one in five patients with heart failure still die within a year of diagnosis.
Those living with heart failure experience a number of debilitating symptoms, including extreme breathlessness and crushing fatigue.
Sufferers are often hospitalised, and there are roughly 86,000 emergency heart failure hospital admissions every year. However, heart failure patients are also more at risk of developing diabetes, which can worsen symptoms and further raise the risk of hospitalisation and death.
Experts say the new research, which involved 6,000 participants, should convince the NHS to expand the rollout of finerenone to thousands of patients with heart failure. ‘There is a clearly detrimental relationship between heart failure and diabetes that has a huge and harmful impact on symptoms and outcomes in patients,’ says Prof John McMurray, consultant cardiologist at the Queen Elizabeth University Hospital, Glasgow.
‘Hopefully, reducing the incidence of new-onset diabetes means that these heart failure patients might have a better quality of life and be at lower subsequent risk of hospitalisation and death.’
DRUG COULD DELAY TYPE ONE FOR YEARS
A game-changing medicine that can delay the onset of type 1 diabetes by several years could eventually be rolled out on the NHS. Type 1 diabetes occurs when the body’s immune system destroys the cells in the pancreas needed to produce insulin – the hormone which keeps blood sugar levels under control.
For children, keeping constant track of their blood sugar levels can also be difficult, and time-consuming. But the new infusion, called teplizumab, prevents the immune system from attacking the pancreas cells in the first place
For most patients, the condition emerges during childhood, meaning they require artificial insulin injections for life.
For children, keeping constant track of their blood sugar levels can also be difficult, and time-consuming for their parents. But the new infusion, called teplizumab, prevents the immune system from attacking the pancreas cells in the first place.
It is taken every day for 14 days. Research suggests it can, on average, delay the onset of type 1 diabetes by three years.
Approximately 400,000 people live with the condition in the UK, including former Prime Minister Theresa May.
The drug has been approved for use in the US, but has not received the sign-off from the NHS. This is partly because experts are still unsure how to identify children at risk of type 1 diabetes.
The condition often runs in families but this is not always an accurate indicator of who will develop it.
A new UK trial could, however, soon answer this question. Researchers funded by Diabetes UK and type 1 diabetes charity Breakthrough T1D are recruiting 20,000 children to a study which aims to work out how to detect those who will and won’t develop the disease.
Its findings could also slash the number of children who end up in A&E with severe diabetes-related complications because they have not been formally diagnosed.
Complications include psychiatric disorders and hypoglycemia, where the blood/sugar level is too low.
Professor Colin Dayan, a diabetes expert at the University of Cardiff, said: ‘I am incredibly excited that treatment to increase the number of years people can live insulin-free is now around the corner.’
VACCINATE AGAINST COMMON VIRUS
Perhaps the most exciting research presented in Madrid was early plans to vaccinate against a virus which may trigger type 1 diabetes.
Researchers have long suspected that coxsackie B, which infects the gut, is linked to the lifelong condition.
Sanjoy Dutta, chief scientific officer at charity Breakthrough T1D, said: ‘Making a vaccine has proved to be incredibly challenging so the success of this trial is fantastically exciting’
Studies suggest that roughly 90 per cent of the population will be infected with the virus, and most will only experience mild cold-like symptoms.
However, in people genetically susceptible to type 1 diabetes, the infection may cause the immune system to attack insulin cells in the pancreas.
In 2017, US pharmaceutical firm Provention Bio announced that it was developing a vaccine against coxsackie B.
It enrolled 32 healthy adults in a first-of-its-kind trial where they received two doses of the jab.
Now, results presented at the conference show that not only was the vaccine well-tolerated but the participants produced antibodies to the virus – meaning that, if exposed to it, they would likely be protected.
Experts at EASD say the next step will be a larger trial involving patients with a raised genetic risk of type 1 diabetes to see if the vaccine prevents them from ever developing the condition.
Sanjoy Dutta, chief scientific officer at charity Breakthrough T1D, which has funded research into coxsackie B, said: ‘Making a vaccine has proved to be incredibly challenging so the success of this trial is fantastically exciting.’
SUGAR MONITORS SAVE BABIES
Women with pregnancy-related diabetes should be offered devices that monitor their blood sugar at all times, researchers say.
Every year, about 35,000 expectant mothers develop so-called gestational diabetes, where their sugar levels rise sharply.
Every year, about 35,000 expectant mothers develop so-called gestational diabetes, where their sugar levels rise sharply
Left untreated, the condition raises the risk that their babies are born obese or even prematurely, leading to long-term health issues.
Half of women with the condition develop type 2 diabetes. Researchers argue that pregnant women with high blood sugar should be offered a continuous blood glucose monitor, They are implants the size of a £2 coin that give constant sugar level updates.
The gadget, usually placed on the back of the upper arm, is already offered to type 1 diabetics, including pregnant women, as well as some type 2 diabetes patients.
Research shows that patients given the monitor are more likely to have well-controlled blood sugar, and therefore fewer side effects, than those who use the traditional finger-prick blood test method.
Prof Claire Meek, a diabetes expert at the University of Leicester, says that NHS recommendations on who should access the monitors were ‘not keeping up with the evidence’ because they do not include gestational diabetes patients.
Prof Meek’s DiGest study is tracking 150 expectant mothers in the UK using continuous glucose monitors and their newborns. The results are due later this year.
