Diabetes: what’s new and what’s next

Research has shown that people who have surgery within five years of being diagnosed with type 2 diabetes have a 70 to 75 per cent chance of a complete remission.

“If you have diabetes for three years, four years, the diabetes can go into remission within some weeks, but if you have ten years of diabetes, the recovery takes more time in the patient and may not happen,” says John’s surgeon, Rudolf Weiner, president of the German Society for Bariatric Surgery, who has performed more than 7500 surgeries since 1993. “People will live longer and have a better quality of life, and they are free from all medications and complications.”

In 2016, more than 45 medical organisations endorsed bariatric surgery for people with moderate to severe obesity and diabetes.

These tablets, which combine two ­diabetes drugs into one medication, have become more commonplace. The availability of particular drugs differs in each country, but a number of combination ­diabetes therapies are widely available in Australia, New Zealand, Singapore and Malaysia. The trend gives ­people fewer tablets to swallow at each sitting, making it easier to follow treatment plans.

“They can end up with three different diabetes medications,” Dr Lawrence says, “and that’s ­before you’ve considered that they’ll be taking treatment, potentially, for their high blood pressure and their cholesterol level.”

How they work Two-in-one treatment is quickly becoming standard for people living with type 2 diabetes. Up to 43 per cent of them now take two or more diabetes drugs, according to a recent international study. They may help diabetes ­patients live healthier lives.

“There are well-known studies that show if you can reduce the number of medications that patients have to take, then you improve their adherence,” Dr Lawrence says. What is double diabetes?

The so-called artificial pancreas, referred to as a ‘hybrid-closed loop’ system, is a ­device that mimics the blood sugar function of a healthy pancreas. It has three parts: a sensor, placed under the skin, for continuous glucose monitoring; a laptop or smart phone component that receives information from the sensor, performs a series of algorithms to predict glucose levels and directs them to the pump; and the pump, which delivers insulin as required to tissue under the skin. A continuous loop is created without the need for human intervention.

How does it work? When Anthony Tudela, 44, does mountain-bike ­racing, he’s no longer concerned that the intense physical exertion will lead to too-low blood sugar, known as ­hypoglycaemia. Since 2017, he’s worn an experimental artificial pancreas known as the Diabeloop DBLG1 ­system, which measures his blood-sugar levels every five minutes and consistently keeps him within target levels. When Tudela plans to physically ­exert himself or eat something, he inputs the data into the Diabeloop interface system on his mobile phone. The artificial pancreas then adjusts his insulin dose accordingly. The complete device checks his blood-sugar levels regularly, so if Tudela over- or under-calculates, the system should be able to adjust to keep ­glucose levels in range.

“I can take sugar immediately, and 15 minutes later, the sugar level is OK,” says Tudela, who was diagnosed with type 1 diabetes at age seven.

Before receiving an artificial pancreas, Tudela’s blood-sugar levels were on target only 30 to 40 per cent of the time. His A1C levels hovered between 11 and 12 per cent, and he experienced hypos regularly.

With the hybrid-closed loop system, Tudela’s blood-sugar levels are on ­target 76 per cent of the time. His A1C levels have decreased to 7.5 per cent, and he doesn’t have hypos anymore, because the device keeps his blood-sugar levels in range.

“With this machine I feel free – I can live as if I wasn’t diabetic,” Tudela says. “But you have to trust the device. For decades, you got accustomed to the idea that you have to control your disease; you are responsible for it. And all of a sudden, the device is responsible. You have to let it go, and it is not so easy.” Check out this extra info on what to eat to feel your best.

You can’t yet buy a hybrid-closed loop system like Tudela’s experimental one, but that could change soon. Diabeloop, a small French company, is in the process of marketing the DBLG1 system, which could become commercially available in the near future.

“Insulin pumps have no intelligence; they just deliver insulin, ­according to a programme developed by the endocrinologist,” says Pierre-Yves Benhamou, head of the endocrinology-diabetology department at the Grenoble University Hospital Centre in France, who’s part of the Diabeloop medical development team. “The DBLG1 system is completely different. The quantity of insulin delivered to the patient adapts all the time according to the blood-sugar level of the patient.”

All of the clinical trials thus far have been done on adults with type 1 ­diabetes, but the next trial will study children and adolescents. The goal is to eventually decrease the risk of hypoglycaemia in all people with type 1 diabetes.

Islet cells in the pancreas make insulin. If they are destroyed, type 1 diabetes is diagnosed. So, wouldn’t transplanting healthy new islet cells fix the problem? Islet cell transplants are available in many countries, ­including Australia, Hong Kong, the UK and some European countries.

“Islet transplantation is only considered if patients have been tried on optimal conventional treatment first,” says Professor Paul Johnson, director of the islet transplant programme at the University of Oxford. “They need to have been treated with the best possible modern insulins and insulin pumps, and despite that, still be getting hypoglycaemic unawareness.” All you need to know about insulin.

How do they work? Islet cell transplants aren’t for everyone. “Islet transplantation is only considered if patients have been tried on optimal conventional treatment first,” says Professor Paul Johnson, director of the islet transplant programme at the University of Oxford. “They need to have been treated with the best possible modern insulins and insulin pumps, and despite that, still be getting hypoglycaemic unawareness.”It’s a much less invasive procedure than a whole pancreas transplant: ­islet cells are typically injected into the liver via the ­portal vein where they start to ­function as they would in the pancreas.

“It isn’t a major operation,” Prof Johnson says. “It’s like having an ­intravenous drip run through. Nearly all the islet transplants are done in the X-ray department, with the patient still awake, but with a local anaesthetic injection over the liver and some sedation.”

Most people need two consecutive islet cell transplants to ensure that the procedure is effective and that the ­islets last. (The cells can last for many years but tend to function for three to five years.) Patients who receive islet cell transplants ­need to take anti-­rejection medication (immunosuppression) for the rest of their lives.

Many people are able to stop taking insulin for some period of time: In a recent study, when 48 people whose type 1 diabetes was extremely difficult to manage (leading to life-threatening low blood sugar ­episodes/hypoglycaemia), received islet cell transplants, 52 per cent had in range glucose levels one year later without insulin.

“Even if they require some insulin, an islet transplant can be life-saving in terms of preventing sudden death of undetected hypos,” Prof Johnson says, “and life-improving by helping to prevent complications such as blindness, ­kidney failure and heart disease ­resulting from high blood sugars.”

Adapted from an article by Sari Harrar. Additional reporting by Victoria Polzot.

Sign up here to get Reader’s Digest’s favourite stories straight to your inbox!