#20 - Breakthrough: ATG slows T1D progression

Hey readers! 👋 Exciting developments in T1D research this week, with promising results from low-dose ATG therapy showing it can actually slow disease progression in newly diagnosed patients. We're also seeing advances in technology with Medtronic's positive data on their automated insulin delivery system and a fascinating new breath test that could detect diabetes in minutes! Let's dive into all the latest research that could make living with T1D a little easier.

New findings support low-dose ATG to delay progression of type 1 diabetes — The MELD-ATG trial has demonstrated that low-dose anti-thymocyte globulin (ATG) can effectively preserve beta-cell function in young people with recently diagnosed T1D. — EASD President Professor Chantal Mathieu

This phase 2 trial enrolled 117 participants aged 5-25 years across eight European countries, testing various doses of ATG against placebo. The standout finding was that a 0.5 mg/kg dose significantly preserved beta-cell function with fewer side effects than higher doses. What makes this particularly exciting is that ATG is already widely available as an affordable drug, making it a potentially accessible treatment option for newly diagnosed patients.

Old Organ Transplant Drug Delayed Beta-Cell Loss in Type 1 Diabetes — A single-day infusion of low-dose ATG preserved stimulated C-peptide levels significantly better than placebo at 12 months. — @medpagetoday

"This cheap drug could be used at the doses we have shown, but the real advantage in my eyes will come when we have humanized ATG that we will be able to redose and perhaps prolong the effects," said Chantal Mathieu, MD. The potential for a cost-effective, practical option to delay beta-cell loss in early T1D is truly promising.

Daily Pill May Slow Progression of Type 1 Diabetes-'Really Exciting Step' — A recent Australian trial demonstrated that a daily pill can slow T1D progression, though benefits were lost when treatment stopped. — newsweek.com

Medtronic reports more positive automated insulin delivery data — The MiniMed 780G system offers meal detection technology and automatic insulin adjustments every five minutes. — Sean Whooley

Medtronic's latest data, presented at the EASD 61st Annual Meeting, shows their MiniMed 780G system provides "rapid, sustained improvements in glycemic control" while significantly reducing patient burden by automating more insulin delivery over time. This comes shortly after FDA approvals and ahead of Medtronic's plan to spin off its Diabetes unit into a standalone company.

Real-World Effectiveness of the MiniMed™ 780G Advanced Hybrid Closed-Loop System for People ≥65 Years — Analysis of data from 8,542 users showed strong glycemic control with an average time in range of 78.4% and low hypoglycemia rates.

The system performed particularly well for users following recommended optimal settings, achieving 81.9% time in range. Importantly, these benefits were consistent across age groups, including those 75 and older, and between T1D and T2D patients. This demonstrates that advanced hybrid closed-loop technology can effectively reduce hypoglycemia and hyperglycemia risks in older adults.

Evaluation of Accuracy and Safety of the 365-Day Implantable Eversense Continuous Glucose Monitoring System — The overall mean absolute relative difference was 8.8% with primarily one calibration per week.

This prospective, multicenter clinical trial evaluated Eversense's 365-day implantable CGM system in 110 adults with diabetes. The system demonstrated high alert detection rates (96.6% at 70 mg/dL and 97.9% at 180 mg/dL), with 90% of sensors remaining functional for the full 365 days. No serious adverse events were reported, confirming its safety and accuracy.

New Breath Test Detects Diabetes in Minutes — Researchers at Penn State University developed a non-invasive sensor that measures acetone levels in exhaled breath. — Penn State University

This innovative test uses laser-induced graphene combined with zinc oxide to detect acetone, a biomarker elevated in diabetic patients. "This sensor only requires that you exhale into a bag, dip the sensor in, and wait a few minutes for results," researchers explained. The technology offers a practical alternative to traditional glucose testing methods and could potentially be used to monitor health changes related to diet and exercise.

Research updates from EASD 2025 — The European Association for the Study of Diabetes Meeting showcased significant advancements in T1D research. — Breakthrough T1D

The 2025 EASD Meeting highlighted several important developments:

"The MELD-ATG results are a noteworthy step forward for disease-modifying therapies; the screening consensus is a much-needed stake in ground around general population screening; we are moving closer to urgently needed adjunctive therapies; and cell therapies continue to perform in clinical and pre-clinical studies. It's an incredibly exciting time in T1D," said Sanjoy Dutta, Ph.D.

Glucose interpretation meaning and action: enhancing type 1 diabetes decision-making with textual descriptions — Adding textual descriptions to glucose monitoring systems significantly improved users' accuracy in interpreting data (85.15% vs. 74.38%).

This study involving 86 participants found that textual descriptions were particularly helpful in ambiguous scenarios like interpreting low glucose compression. Despite better performance, users of the new system had a less favorable perception of it, highlighting the need for improved user acceptance alongside technological advancements.

Explainable cluster-based learning for prediction of postprandial glycemic events and insulin dose optimization — This framework predicts postprandial hypoglycemia and hyperglycemia within a 4-hour window using cluster-personalized ensemble models.

The approach uses a hybrid clustering method to identify glycemic profiles and develop personalized models that outperformed baseline methods. An insulin adjustment module improved pre-meal bolus recommendations, enhancing postprandial time-in-range and reducing hypoglycemia without increasing hyperglycemia.

Effects of continuous and interval training on inflammatory and vascular adhesion markers in sedentary individuals with type 1 diabetes — High-intensity interval training increased IL-10 levels in individuals with T1D.

This study found that people with T1D tend to have lower anti-inflammatory interleukin 10 (IL-10) and higher intercellular adhesion molecule 1 (ICAM1) levels. Exercise-induced reductions in adhesion molecules were greater in individuals with higher baseline fitness, highlighting how physical activity and fitness levels influence individual responses to exercise.

Stress and Health-Related Quality of Life in Adults With Type 1 Diabetes — Diabetes-related stress was the strongest predictor of lower health-related quality of life.

This study of 772 Spanish adults with T1D found that perceived social support partially mediates the impact of stress on quality of life and sequentially affects treatment adherence. The findings highlight the importance of addressing psychosocial factors such as stress and social support in diabetes care.

Young Adult Diabetes Technology Use in Pediatric as compared to Adult Practices — Young adults in adult care settings are more likely to have poor glycemic control and less likely to use diabetes management technologies.

This T1D Exchange study found that young adults transitioning from pediatric to adult care face challenges in maintaining glycemic control and technology use. Patients in adult care were more likely to have undocumented insurance status and less likely to use continuous glucose monitors or insulin pumps compared to those in pediatric care.

DT1 y perimenopausia: consejos reales de mujeres que ya la vivieron — Perimenopause causes hormonal fluctuations that make managing Type 1 Diabetes more difficult. — Hannah Doskicz

This article from T1D Exchange gathered real-life advice from women who have experienced the challenging intersection of T1D and perimenopause. Key recommendations include finding knowledgeable healthcare providers, preparing for perimenopause's impact on diabetes management, self-advocacy, and accepting that glucose fluctuations during this time are due to hormonal changes rather than personal failure.

Nutrition among older adults with type 1 diabetes — A survey of 77 older adults (65+) with T1D found sub-optimal intakes of fruits, vegetables, whole grains, fiber, calcium, dairy, and added sugars.

These nutritional deficiencies may have significant implications for the health and diabetes management of older adults with T1D, highlighting an often overlooked aspect of care for this growing population.

Efficacy of the Online Interactive Podcast Program "Living With Type 1 Diabetes to Grown-Up" — This study is evaluating a podcast program designed to support adolescents with T1D transitioning to adulthood.

The trial includes 88 participants from two medical centers in Taiwan, comparing the podcast intervention against an e-book on diabetes transition. The 3-month intervention includes 36 podcast episodes focusing on disease management and psychosocial support. This is the first evidence-based, rigorously designed podcast program targeting this specific transition phase.

Type 1 Diabetes Care: The West Bengal Model — India has the highest number of children and adolescents with T1D but lacks a national health program to support this population.

The average life expectancy for individuals diagnosed with T1D in India is only 29 years, highlighting the urgent need for structured care models. The West Bengal model offers a potential framework to address these challenges in a country where many T1D patients face untimely death due to lack of proper care.

Improving type 1 diabetes care globally: the importance of medical education — Medical education plays a critical role in enhancing the management and care of T1D worldwide.

This article emphasizes the need for improved training and education of healthcare professionals to better address the challenges of T1D care on a global scale, potentially reducing disparities in diabetes care across different regions.

Monocyte/macrophage-derived interleukin-15 mediates the pro-inflammatory phenotype of CD226+ B cells in type 1 diabetes — CD226+ B cells are increased in T1D patients and correlate positively with disease severity.

This study reveals that interleukin-15 (IL-15) secreted by monocytes and macrophages enhances the inflammatory response of CD226+ B cells. Blocking IL-15 signaling with specific antibodies effectively prevented T1D onset in a mouse model and, when combined with anti-CD3 therapy, reversed hyperglycemia. This identifies a novel immunopathogenic mechanism and potential therapeutic target.

Analysis of vitamin D-induced immunomodulatory gene expression changes in type 1 diabetes — Vitamin D treatment downregulated most inflammatory genes in T1D patients.

The study identified 100 differentially expressed genes shared between T1D and vitamin D-treated samples, with 58 showing opposite regulation. Six key immune-related genes were highlighted, with vitamin D generally downregulating their expression. These findings suggest vitamin D's potential as an adjunctive therapy for immune regulation in T1D.

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