#18 - Insulin-producing cells without drugs? 🌟

Hey readers! 🌟 Exciting breakthroughs in T1D research this week! From genetically modified cell transplants that produce insulin without immunosuppression to a new pregnancy-specific artificial pancreas system, science is moving faster than ever. Plus, we've got practical insights on exercise, travel tips, and the latest CGM tech approvals. Let's dive into the latest developments that could change the future of diabetes care.

Type 1 Diabetes Patient's Insulin Production Restored with New Cell Transplant Therapy — Researchers have successfully treated a T1D patient with genetically modified insulin-producing cells that evade immune system attacks, eliminating the need for immunosuppressant drugs. – Humberto Basilio

This groundbreaking therapy used CRISPR gene editing to modify donor pancreatic cells, allowing them to hide from immune detection while producing insulin in the recipient's body. Though the 42-year-old patient still requires some insulin injections, the transplanted cells produced insulin independently for the first time. "This is the most exciting moment of my scientific career," says cell biologist Per-Ola Carlsson, who helped develop the procedure. The combination of immune evasion and insulin production creates "the possibility of a cure for type 1 diabetes," though longer-term monitoring is still needed.

NHS rolls out new generation 'artificial pancreas' to help pregnant diabetic women — NHS England is providing a pregnancy-specific hybrid closed loop system for women with T1D who are pregnant or planning pregnancy. – NHS England

This technology combines an insulin pump, glucose sensor, and algorithm to deliver precise insulin doses with pregnancy-specific glucose targets. Around 2,000 women with T1D become pregnant annually in England, and this system reduces the need for finger prick tests while enabling remote monitoring by diabetes teams. Over 600 pregnant women have already benefited, with one user reporting: "For the first time in her life, Nina woke up every single morning with a completely normal glucose level, and achieved a full night's sleep." The £3.7 million initiative is part of NHS England's broader effort to improve maternal outcomes.

FDA Clears MiniMed 780G System to Enable Integration with Abbott's Instinct Sensor and Approves Use in Type 2 Diabetes — Medtronic's insulin pump system receives expanded approval for integration with Abbott's new CGM and use in adults with type 2 diabetes.

This FDA clearance marks a significant advancement in automated insulin delivery technology. The Instinct sensor, described as the smallest and thinnest integrated CGM with up to 15 days of wear time, will pair with Medtronic's system to offer more seamless diabetes management. Clinical trials showed impressive results for type 2 diabetes patients, with a 0.7% reduction in HbA1c and increased time in range to 81%. "This approval extends the benefits of automated insulin delivery to people with type 2 diabetes," notes Natalie Bellini, Endocrine Nurse Practitioner.

Optimal type and dose of exercise to improve glycated haemoglobin in individuals with type 1 diabetes — A systematic review reveals that combining aerobic and resistance training is most effective for improving HbA1c in T1D. – John Wiley & Sons Ltd.

This comprehensive analysis found that only multi-component exercise (ME), which combines aerobic and resistance training, significantly reduced HbA1c levels by approximately 0.81%. The study identified an L-shaped dose-response relationship, with clinically meaningful HbA1c reductions achieved at relatively low exercise doses (160 MET-min/week, equivalent to about 25 minutes per week). For adolescents with T1D, researchers recommend combining aerobic and resistance training for at least 12 weeks with 160 to 1200 MET-min/week to optimize metabolic benefits while minimizing exercise burden.

Automated Insulin Delivery Systems Improve Glucose Management in Children with T1D — A meta-analysis of 11 clinical trials shows AID systems reduce HbA1c by 0.41% and increase time in range by 11.5% in youth.

This systematic review analyzed data from 901 participants aged 6-18 years, finding that automated insulin delivery systems significantly improved glucose management compared to other insulin regimens. The benefits were especially pronounced during nighttime, with a 19.7% increase in time in range. AID systems also reduced time spent in both hypoglycemia and hyperglycemia without increasing adverse events. These findings support the growing adoption of AID technology in pediatric diabetes care.

Cell-targeted PD-1 agonists show promise for T1D treatment — Immunocore develops bispecific molecule targeting pancreatic β-cells to suppress NK cell activity. – Immunocore Ltd

This innovative approach uses a bispecific PD-1 agonist molecule designed to inhibit natural killer (NK) cell activity specifically in pancreatic tissue. The molecule targets β-cells by binding to a pre-pro-insulin peptide and delivers a PD-1 agonist signal to suppress NK cell inflammatory and cytotoxic functions. Experimental results show it accumulates at the immunological synapse, modulates NK cell gene expression, and protects β-cells from damage. This tissue-specific immune suppression could offer a promising therapeutic approach for type 1 diabetes without the side effects of systemic immunosuppression.

Calorie and time-restricted feeding improves liver and kidney health in T1D rats — Study shows dietary intervention attenuates organ damage in streptozotocin-induced diabetes model.

While calorie restriction combined with time-restricted feeding didn't significantly improve body weight in diabetic rats, it markedly reduced water intake and improved hepatomegaly. Most importantly, histological analysis revealed that this dietary approach significantly attenuated liver and kidney damage, preserving tissue architecture and reducing vacuolation. These findings suggest that calorie and time-restricted feeding may serve as a beneficial adjunct therapy for metabolic and organ complications in T1D, warranting further translational research.

Traveling with Diabetes: CGM Airport Security Tips — Practical advice for traveling with the Eversense 365 CGM system.

Traveling with diabetes just got easier! The Eversense 365 CGM system allows for lighter packing with only essential supplies needed. You can safely pass through airport security without removing your smart transmitter or sensor—just inform security and show a Medical Device Notification Card. Your Bluetooth-enabled vibration alerts will work during flights even if your phone is in airplane mode, and the smart transmitter automatically updates to the local time zone upon arrival. For swimming, remember the transmitter can be removed or worn with water exposure limited to 1 meter depth for 30 minutes.

Climbing Mt. Whitney with Type 1 Diabetes (Twice) — Ayla Kanow shares her experience guiding teens with T1D up California's highest peak.

This inspiring story follows Ayla Kanow's journey climbing Mt. Whitney twice with type 1 diabetes—first as a teenager and later as a leader guiding other teens with T1D. The experience taught valuable lessons about balancing health metrics with joy: "Time in range is important for health, but time in happiness is just as important — or more important — especially in the mountains." Kanow emphasizes that diabetes management requires creativity and flexibility, likening it to "an abstract piece of art" where the same breakfast can yield completely different results from day to day. Most importantly, the climb reinforced that their accomplishments came "because of diabetes, not in spite of it."

Continuous Glucose Monitoring Expands, Yet Access Remains Unequal — Study highlights disparities in diabetes technology access despite overall growth.

A recent JAMA Network Open study shows significant growth in CGM and insulin pump use among people with T1D from 2009 to 2023. However, only about 19% of youths and 28% of adults achieved recommended glucose control levels (HbA1c <7%). Technology use remains highest among younger, non-Hispanic White, and commercially insured patients, with notable disparities among racial and ethnic minorities, uninsured individuals, and those with lower socioeconomic status. "While we should be celebrating the improvements, we must remember that most patients with Type 1 diabetes don't have optimal glucose control, and there is a lot of room for improvement," said Jung-Im Shin, M.D., Ph.D.

Clinical and Demographic Characteristics Associated with Type 1 Diabetes Distress in Latin American Children — Study finds 28% of Latin American children with T1D experience high diabetes distress.

This cross-sectional study conducted in Argentina and Chile assessed diabetes-specific distress in 143 children aged 8-17 years with T1D. Using the Problem Areas in Diabetes (PAID) questionnaire, researchers found that higher diabetes distress was significantly associated with poorer glycemic control as indicated by higher HbA1c levels. Children living with only one parent were more likely to have moderate or high distress. Multiple logistic regression showed that each 1% increase in HbA1c raised the odds of high distress by 48%, suggesting that addressing diabetes distress could improve glycemic outcomes in this population.

Perceptions of Novel Therapies for Type 1 Diabetes — Qualitative study explores patient and caregiver views on emerging treatments.

Interviews with 26 participants revealed that while diabetes and insulin therapy significantly impact daily life and can lead to burnout, most were open to trying new therapies. Disease-modifying treatments were valued for potential benefits like reduced insulin dependence and prolonging the honeymoon period, though cancer risk was a common concern. Cell replacement therapies were widely considered promising due to the possibility of insulin independence and restored pancreatic function, despite concerns about immunosuppressant use and surgical risks. The study highlights the importance of involving patients and caregivers in evaluating new treatments with novel risks and benefits.

Extrapolated Time in Range Predicts Pregnancy Outcomes in T1D — Higher time in range associated with better maternal and neonatal outcomes.

This retrospective study of 140 pregnancies found that higher extrapolated time in range (eTIR) values from self-monitoring of blood glucose were associated with significantly reduced risks of preterm birth, neonatal respiratory distress, and large for gestational age infants. Women with eTIR above 50% had significantly lower odds of these complications compared to those with eTIR below 50%. These findings emphasize the importance of maintaining glucose levels within target ranges during pregnancy and support the use of SMBG-derived eTIR as a useful metric for predicting pregnancy outcomes in T1D patients.

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