#26 - Beta cells from alpha cells? 🔬✨

Hey readers! 🎉

This week brings a wave of exciting developments, from breakthrough research on beta cell regeneration that could transform how we think about a cure, to real-world data showing how modern technology is reshaping daily diabetes management. We're also diving into the latest on automated insulin delivery systems and what they mean for reducing the mental load of T1D.

Mount Sinai researchers have made a breakthrough in understanding how harmine and related DYRK1A inhibitors stimulate human beta cell regeneration, potentially offering a path to an affordable, scalable treatment for both type 1 and type 2 diabetes. The most exciting finding? Regenerated beta cells may originate from alpha cells, suggesting that people with diabetes have a large latent reservoir of potential beta cells just waiting to be activated. Harmine alone can increase beta cell mass by about 300%, and when combined with a GLP-1 receptor agonist like semaglutide, that increase jumps to 700%. Published in Cell Reports Medicine, this work moves us closer to human trials with a simple pill-based therapy that could be accessible to millions. – Medical Xpress

The CIRCUIT trial has delivered compelling evidence that closed-loop insulin delivery significantly improves glycemic control during pregnancy for women with type 1 diabetes. Across 14 centers in Canada and Australia, pregnant participants using closed-loop systems spent 65.4% of time in the pregnancy-specific glucose range (63-140 mg/dL) compared to just 50.3% with standard care, a difference of 12.5 percentage points. This improvement came with a favorable safety profile, with only one severe hypoglycemia event in the closed-loop group. The findings strongly support the use of automated insulin delivery during pregnancy, a time when tight glucose control is critical for both maternal and fetal health. – Patricia Lemieux

A comprehensive congress report highlights how the field is shifting from lifelong insulin management toward functional cures through beta cell replacement combined with strategies to avoid chronic immunosuppression. The VX-880 FORWARD trial showed remarkable results with stem cell-derived islet infusions: all 12 participants achieved durable C-peptide production by day 90, eliminated severe hypoglycemic events, and 83% achieved insulin independence at 12 months. Meanwhile, parallel advances in precision immunomodulation (engineered antigen-specific regulatory T cells, fully human ATG SAB-142) and bioengineering (non-fibrotic hydrogels that enable long-term graft function without systemic immunosuppression in animals) are converging to make safe, scalable cell replacement a realistic near-term goal. – EMJ Diabetes

Tandem Diabetes Care has launched integration between its t:slim X2 insulin pump and Abbott's FreeStyle Libre 3 Plus CGM sensor in the U.S., with a global rollout planned throughout 2026. The integration features real-time glucose data transmission, an extended 15-day sensor wear time, and the advanced Control-IQ+ system with its unique AutoBolus feature that automatically calculates and delivers correction boluses for missed meals. Current t:slim X2 users can access this feature through a free software update, making it easier than ever to benefit from the latest technology without replacing hardware. – Jasmin Pennic

A large-scale analysis of the Omnipod DASH tubeless insulin pump combined with the myDiabby Healthcare data management platform examined outcomes from 14,757 French users (93.7% with type 1 diabetes) over a median of 1.4-1.5 years. People with T1D achieved a median time in range of 52.5%, while those with T2D reached 66.9%, with notably low hypoglycemia exposure (median time below range of just 3.7%). While only 12.6% of T1D users reached the guideline target of ≥70% time in range, the study demonstrates that tubeless pump users achieved moderate glycemic control with favorable safety metrics and consistent device use, highlighting the value of large, high-quality data management platforms for both research and clinical care. – PubMed

A pilot randomized trial tested a fully automated closed-loop system delivering both insulin and pramlintide to eliminate the need for carbohydrate counting in adults with type 1 diabetes. Over 14 hours of outpatient activity, the system maintained similar time-in-range compared to standard therapy with carb counting, though times spent below target were numerically higher in some fully closed-loop arms. The results suggest that automated insulin-pramlintide systems have the potential to alleviate the burden of carbohydrate counting without degrading glycemic control, with a larger, longer trial now underway to confirm these promising findings. – PubMed

Research published in the Journal of the Endocrine Society reveals altered glucagon responses during oral glucose tolerance tests at different stages of type 1 diabetes development. The study found that fasting plasma glucagon levels increase with disease progression, and identified a unique paradoxical increase in glucagon at 15 minutes only in early stage 3 type 1 diabetes. These findings highlight that altered alpha-cell function may play a significant role in disease progression, suggesting that future therapies may need to target both alpha- and beta-cell functions rather than focusing solely on insulin replacement. – Oxford University Press

FDA Approves First Insertion-Free Glucose Sensor: The Biolinq Shine has received FDA approval as the first insertion-free glucose sensor that also monitors activity and sleep, designed for people with type 2 diabetes not on insulin and expanding access to continuous glucose monitoring. – Beyond Type 1

Tubeless Pumps Improve Quality of Life: A time trade-off study found that tubeless insulin delivery systems are associated with significantly higher health-state utility values compared to tubed systems, with automated insulin delivery providing additional benefits, suggesting improved quality of life for users. – Insulet International Ltd.

Pattern Recognition for Better AID: Block-based Recurrence Quantification Analysis offers a novel approach to automatically identify complex physiological and behavioral patterns in multidimensional diabetes data, potentially improving automated insulin delivery by targeting patterns that lead to hyperglycemia. – PubMed

Digital Health Platform for Pediatric Care: A six-month pilot study of a co-designed digital health platform for pediatric type 1 diabetes care found that caregivers felt more prepared and empowered, with nearly all healthcare providers satisfied with the platform's ability to support clinical visits. – Amed et al.

The American Diabetes Association continues to fund critical research, with recent highlights including identification of Hybrid Insulin Peptides as new autoantigens in type 1 diabetes, development of novel non-enzymatic molecules for continuous glucose monitoring, and promising immunomodulatory approaches using IgM supplementation that reversed new-onset diabetes in mouse models. These advances represent important steps toward better diagnostics, treatments, and prevention strategies.

Beyond Type 1 offers comprehensive resources covering daily diabetes management, technology, complications, insurance navigation, mental health, pregnancy, and community programs including Get Insulin, Beyond Ambassadors, and Beyond Scholars to help people thrive with type 1 diabetes.

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