#21 - Baricitinib: A T1D Game-Changer? 🌟

Hey readers! 🌟 It's been an exciting week in the world of Type 1 diabetes research and technology. From promising new medications that could slow disease progression to innovative needle-free glucose monitoring systems, there's a lot to unpack. I'm particularly excited about the baricitinib studies showing preservation of beta cell function in newly diagnosed patients - this could be a game-changer for those in the early stages of T1D. Let's dive into this week's developments!

Baricitinib Effective In Slowing Type 1 Diabetes Progression — Researchers presented exciting findings at the European Association for the Study of Diabetes meeting showing that baricitinib, an oral drug typically used for rheumatoid arthritis, can slow the progression of type 1 diabetes in newly diagnosed patients. – Drugs.com

The study involved 117 participants aged 5-25 who received various doses of baricitinib over 48 weeks. The 2.5 mg/kg dose was most effective at preserving beta cell function, though a lower 0.5 mg/kg dose also showed significant benefits with fewer side effects. "For the first time, we have an oral disease-modifying treatment that can intervene early enough to allow people with type 1 diabetes to be significantly less dependent on insulin treatment," said lead researcher Michaela Waibel. If larger phase III trials are successful, baricitinib could be approved for T1D treatment within five years.

Existing drug slows progression of type 1 diabetes in newly diagnosed — Another promising treatment option comes from researchers at UZ Leuven, who found that antithymocyte globulin (ATG), an immune-suppressing drug used to prevent organ transplant rejection, can also slow T1D progression. – Paul McClure

This study, published in The Lancet, tested ATG in doses ranging from 0.1 to 2.5 mg/kg. Like the baricitinib study, researchers found that while the highest dose was most effective, a lower dose (0.5 mg/kg) provided significant benefits with fewer side effects. This represents another potential therapy that could modify the course of T1D after diagnosis rather than just managing symptoms.

The future of type 1 diabetes therapy — This comprehensive review highlights several promising avenues for T1D treatment, including immunotherapies, early diagnosis through screening, and advanced β-cell replacement therapies. – PubMed

The FDA's approval of teplizumab (Tzield) as the first immunotherapy to delay clinical onset of T1D represents a significant milestone. Public health screening using islet autoantibodies is expanding, enabling earlier diagnosis and timely intervention. Meanwhile, β-cell replacement is transitioning from donor transplants to stem cell-derived β cells, with bioengineering and gene editing techniques potentially reducing the need for immunosuppression.

Decision Support Tool for Self-Management of Insulin Dosing in Type 1 Diabetes — A proof-of-concept study evaluated an AI-driven decision support system that provides insulin dosing recommendations to individuals with T1D using multiple daily injections. – PubMed

Over a 12-week intervention period, 16 young adults with T1D used the system alongside continuous glucose monitoring. The results were impressive: median HbA1c decreased significantly from 7.5% to 7.1%, and time in range improved by 3.5%, without increasing hypoglycemia risk. These findings support further investigation of AI-powered tools to enhance diabetes management.

Biolinq gets FDA de novo nod for intradermal glucose sensor — The FDA has granted de novo classification to Biolinq Shine, a needle-free continuous glucose monitor designed primarily for people with Type 2 diabetes who don't use insulin. – Elise Reuter

Unlike traditional CGMs that use a needle to insert a sensor beneath the skin, Biolinq Shine uses a microsensor array that sits more shallowly in the skin, making it more comfortable. The device features a color LED display to indicate glucose levels and tracks sleep and activity data via an app. Biolinq plans to expand its capabilities to measure multiple analytes such as ketones and lactate in the future.

The Most Exciting Diabetes Technology Updates: Summer 2025 Edition — The American Diabetes Association's 2025 Scientific Sessions showcased significant advancements in diabetes technology, from AI predictive modeling to new insulin delivery systems. – Beyond Type 1

AI tools can now predict type 1 diabetes up to a year before symptoms appear, enabling earlier intervention. New insulin delivery devices such as Medtronic's MiniMed Fit patch pump and Beta Bionics' Mint tubeless pump offer more personalized, discreet options. Beta cell therapies like Vertex's zimislecel show promise in restoring insulin production, with all 12 patients in a study reaching healthy blood sugar levels and 10 no longer needing insulin after a year.

FreeStyle Libre 3 — The world's smallest continuous glucose monitoring sensor streams real-time glucose readings directly to a smartphone app. – Binson's Medical Equipment & Supplies

Each sensor lasts up to 14 days, is applied to the back of the upper arm, and automatically records glucose every 15 minutes with updates every minute. The sensor can be worn during daily activities including bathing and exercise, and communicates with the phone within a 33-foot range.

#1638 Heavy - Part 1 — This moving episode of the Juicebox Podcast features an interview with B, a mother of a toddler diagnosed with type 1 diabetes at 18 months. – Scott Benner

B shares her journey through diagnosis, hospital stay, and the challenges of managing diabetes in a very young child. "I say that diabetes is my second kid. We actually were gonna, we were thinking about having another, but he got the diabetes. And I was like, oh, okay, you wanted to be an only child. I understood." Her story highlights the emotional and physical toll of constant monitoring, insulin dosing, and the mental burden on parents of children with T1D.

#1631 Glucose Guardians — In this episode, Scott Benner interviews Jacob Ritzert, a 27-year-old with type 1 diabetes who shares his journey from diagnosis to managing his condition. – Scott Benner

Jacob was diagnosed at age 25 and initially used his nutrition background to achieve tight control manually, getting his A1c from 11.5% to 5.5%. However, this led to frequent hypoglycemia and eventually a seizure. After transitioning to automated insulin delivery with Omnipod 5 and Dexcom G6, he experienced improved quality of life with fewer lows. "I feel like diabetes isn't so much of a hassle anymore," Jacob shares, highlighting how technology can transform the diabetes management experience.

Retinopathy and nephropathy in type 1 diabetes: role of HbA1c and blood pressure variability — This nationwide cohort study from the Swedish National Diabetes Register investigated the impact of variability in HbA1c and blood pressure on the development of retinopathy and nephropathy in individuals with T1D. – PubMed

The study followed 9,358 patients for an average of 10.7 years and found that higher variability in systolic and diastolic blood pressure, as well as HbA1c, was significantly associated with increased risks of microvascular complications. This suggests that beyond controlling mean levels, maintaining stable blood pressure and HbA1c may be crucial in preventing progression of diabetic complications.

Physical Activity Support Can Improve Outcomes in Youth With Type 1 Diabetes — This article highlights the positive association between physical activity and improved glycemic outcomes in youth newly diagnosed with Type 1 diabetes. – PubMed

Support programs like the 4T Exercise Program can enhance diabetes management outcomes in young patients. The findings emphasize the importance of incorporating physical activity support into comprehensive diabetes care for youth.

Effects of continuous and interval training on inflammatory markers in type 1 diabetes — This study investigates how different exercise types affect inflammatory and vascular markers in sedentary adults with T1D compared to healthy controls. – PubMed

High-intensity interval training (HIIT) increased anti-inflammatory interleukin 10 (IL-10) levels in individuals with T1D, while continuous training reduced vascular cell adhesion molecule 1 (VCAM1) in controls. The findings suggest that exercise modality and baseline fitness impact inflammatory responses, with potential implications for cardiovascular health in T1D.

The Future of Insulin: Where We Are Now & What Comes Next — This Diabetech video podcast explores current and future innovations in insulin therapy. – Diabetech

The discussion covers ultra-rapid insulins, inhaled insulin (Aphresa/Fresza), weekly long-acting insulin injections, smart insulin that activates only when needed, and oral insulin pills. "Aphresa works faster than any injected insulin including Lyumjev and Fiasp, and it clears faster as well, much more closely mimicking what the human body does," notes one expert. Weekly long-acting insulins could be available as early as 2024, while smart insulin that only activates when blood sugar is high remains in early research stages.

Alpha Cells Moonlight as Secret GLP-1 Factories — A fascinating discovery from Duke University School of Medicine reveals that pancreatic alpha cells produce not only glucagon but also significant amounts of GLP-1, a hormone that boosts insulin release. – Shantell Kirkendoll

This finding challenges existing views on blood sugar regulation and suggests that alpha cells have a flexible hormone output that can support beta cells. "Alpha cells are more flexible than we imagined. They can adjust their hormone output to support beta cells and maintain blood sugar balance," researchers noted. This discovery could potentially lead to new therapeutic approaches that boost the body's own GLP-1 production.

Insulin Delivery Device Market to Grow at a CAGR of 15.5% from 2025 to 2032 — The global insulin delivery device market is projected to grow significantly from US$11.7 billion in 2025 to US$31.98 billion by 2032. – Persistence Market Research

This growth is driven by the rising prevalence of diabetes worldwide, technological advancements such as smart and connected devices, and increasing patient preference for minimally invasive insulin delivery methods. Insulin pens currently dominate the market due to their ease of use and affordability, while insulin pumps are rapidly gaining traction for continuous and personalized therapy.

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