#25 - 83% insulin-free with stem cells 🔬

Hey readers! 🎉

This week brings remarkable news from the frontiers of T1D research and care. From stem cell therapies showing real insulin independence to year-long CGM sensors proving their worth, we're witnessing genuine breakthroughs alongside practical improvements in everyday management tools. Let's dive into what matters most for your health and future.

Stem Cell–Derived, Fully Differentiated Islets for Type 1 Diabetes represents a watershed moment in T1D treatment. This phase 1-2 trial of zimislecel, an allogeneic stem cell-derived islet therapy, demonstrated that 83% of participants achieved insulin independence by day 365. All 14 participants showed engraftment and detectable C-peptide levels, with 12 out of 12 in the full-dose group maintaining HbA1c below 7% without severe hypoglycemic events. While neutropenia emerged as the most common serious adverse event in three participants, these results validate the hypothesis that stem cell therapy can restore physiologic islet function. – New England Journal of Medicine

The implications extend beyond individual treatment. A continuously oxygenated macroencapsulation system addresses one of cell therapy's biggest challenges: keeping transplanted cells alive. Researchers developed an implantable electrochemical oxygen generator that maintains cell viability under hypoxic conditions, successfully reversing diabetes in rats for three months without immunosuppression. This innovation could make cell-based therapies more practical and accessible. – PubMed

The ENHANCE study validated the Eversense 365-day implantable CGM system across 110 participants, demonstrating remarkable accuracy with an 8.8% mean absolute relative difference and 96.6% hypoglycemia alert detection at 70 mg/dL. Ninety percent of sensors survived the full year with primarily weekly calibrations, and no serious device-related adverse events occurred. This represents a significant leap forward in reducing the burden of sensor changes while maintaining clinical-grade accuracy. – PubMed

Multiple studies this week reinforced AID's transformative potential across diverse populations. The CIRCUIT trialshowed pregnant women with T1D using closed-loop systems spent 65.4% of time in pregnancy-specific range (63-140 mg/dL) versus 50.3% with standard care, an adjusted difference of 12.5 percentage points. Safety remained acceptable with one severe hypoglycemia episode and two DKA cases in the closed-loop group. – PubMed

Young children aged 2-6 years benefited substantially from the Medtronic MiniMed 780G system in a real-world study of 149 children. Time in range increased from 56.8% to 66.6%, HbA1c dropped from 7.6% to 7.2%, and hypoglycemia time remained stable at around 5%. Parents reported reduced diabetes burden, and the safety profile proved favorable with no severe hypoglycemia hospitalizations over 12 months. – PubMed

Even people with type 2 diabetes showed substantial glycemic improvement using Control-IQ technology. The 30-participant trial demonstrated a 15% increase in time in range (approximately 3.6 additional hours daily) and a 22 mg/dL reduction in mean glucose, all without increased hypoglycemia. – American Diabetes Association

The Lancet's comprehensive review maps the evolving treatment landscape with remarkable clarity. Teplizumab's approval as the first immunotherapy to delay clinical onset marks a paradigm shift, while stem cell-derived β-cell therapies move from donor transplants toward scalable solutions. Automated insulin delivery systems now routinely improve time in range by 10-15 percentage points, and new-generation insulins better mimic physiological action. The review emphasizes that structured screening for islet autoantibodies must become standard practice, supported by international guidelines and equitable funding. – The Lancet

The AID-JUNCT trial protocol outlines the first prospective randomized study testing tirzepatide (a dual GIP/GLP-1 receptor agonist) alongside automated insulin delivery in adults with T1D. With 42 participants randomized to receive either tirzepatide plus AID or standard care plus AID for 16 weeks, researchers will measure changes in time in range as the primary endpoint. This represents an important step toward understanding whether adjunct therapies can push glycemic outcomes beyond what insulin alone achieves. – PLOS ONE

Current prevention efforts remain limited but promising. While teplizumab stands as the only FDA-approved therapy to delay Stage 3 T1D onset, multiple approaches targeting immune cells, cytokines, and antigens are under investigation. The challenge lies in achieving durable benefits, as Stage 3 interventions have consistently shown only temporary improvements in beta-cell function. Future research must refine patient selection, identify new therapeutic targets, and optimize timing to extend immunotherapy responses. – Diabetes/Metabolism Research and Reviews

Other Notable Developments:

The convergence of these advances, from cellular therapies to smarter algorithms to preventive immunotherapies, suggests we're entering an era where T1D management will look fundamentally different. Each innovation builds on the last, creating a comprehensive ecosystem of care that addresses the disease from multiple angles simultaneously.

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