By: Esha Shakthy, Nutritional Sciences ‘25
Diabetes is one of the leading causes of death and disability worldwide. Lancet estimates that over 1.31 billion individuals worldwide may have diabetes by 2050 [1]. More than 133 million Americans are living with diabetes or pre-diabetes today,which places a substantial burden on health-care systems. In 2021, diabetes related health expenditures were over $966 billion worldwide, per International Diabetes Federation. Therefore, monitoring and managing diabetes is crucial for our individuals living with the condition. There is ongoing research and innovation to enhance diabetes management, treatment, and potentially, investigating a cure. This article aims to shed light on the latest innovative advancements in diabetes monitoring, insulin therapy, and insulin delivery, along with promising breakthroughs in alternative therapies, and emerging research from the past year.
The treatment for diabetes was revolutionized by the discovery of insulin in the early 1920s, allowing diabetes patients to manage their blood sugar levels efficiently [2]. Recently there have been promising advancements in insulin therapy with the emergence of wearable and implantable devices for insulin release which offer better control and convenience control for patients. Insulin pump is one such device that can deliver a continuous supply of rapid-acting insulin through a catheter placed under the skin. The pump mimics the natural insulin release of a healthy pancreas, by administering precise doses of insulin throughout the day. Advanced devices such as Closed-loop Insulin Delivery Systems combine a continuous glucose monitoring sensor, an insulin pump, and a control algorithm to continuously monitor blood sugar levels and adjust insulin delivery accordingly. The control algorithms can analyze trends and patterns to predict future blood sugar levels and provide personalized recommendations [2].
Novel approaches to insulin delivery, such as the use of nanomaterials for oral administration has been an emerging area of focus [5]. Nanotechnology involves the use of nanoparticles (<100 nm). At this juncture, researchers are trying to develop different insulin delivery systems, especially through oral and pulmonary routes using nanocarrier based delivery systems. This next generation efficient therapy for diabetes may help to improve the quality of life of diabetic patients who routinely employ insulin by the subcutaneous route [5].
New insulin-independent therapies are a key breakthrough in treating diabetes. Teplizumab, a humanized monoclonal antibody, targets the T cells by binding to CD3, and has shown the ability to delay the onset of type 1 diabetes. In November 2022, teplizumab became the first FDA-approved drug for delaying the progress of type 1 diabetes [3].
In the recent past, gene therapy is gaining interest as researchers have identified many genes accountable for the evolution of diabetes. By employing gene therapy techniques and alteration of target genes could lead to potential cure for diabetes [4]. For example, Stearoyl-CoA desaturase-1 (SCD1) catalyzes the rate-limiting step of unsaturated fatty acid (FA) biosynthesis in human cells. The missense rs2234970 single nucleotide polymorphism (SNP) in SCD1 was recently found to be contributing to the onset of obesity-related metabolic disorders, such as Type 2 diabetes. Studies have also found association between SNPs in insulin and insulin receptor genes and the reduced synthesis of anti-insulin antibodies, but poor glycemic control [6].
The stem cell therapy is also emerging as a key of research, aiming to replace malfunctioning pancreatic cells with multipotent stem cells, exploiting the ability of various kinds of stem cells such as induced pluripotent stem cells (iPSCs), embryonic stem cells (ESCs), and adult stem cells. Studies with animal models have indicated that a small number of pancreatic tissue when made available could bring back the optimum pancreatic beta-cell mass [3].
Medical nutrition therapy (MNT) is a critical aspect of diabetes education and management, which has made great strides, including nutrition diagnosis and therapeutic and professional counseling services that aid in the management of diabetes [3]. Recommendations on MNT by international collaborative groups for diabetes management have attempted to reform and provide courses for adverse nutritional transition. By crafting patient-focused diet strategies, diabetologists and registered dieticians are partnering to develop nutritional guidelines based on evidence for the prevention and management of Diabetes [3].
Staying informed about advancements in treatments along with awareness about the risk factors and healthy lifestyle are essential for diabetes management and prevention. While the most common diabetes treatments revolve around managing blood glucose levels, the novel approaches to insulin delivery and emerging research around potential treatments generates optimism for improved health and future cures.
References:
The Lancet (2023). Diabetes: a defining disease of the 21st century. Lancet (London, England), 401(10394), 2087. https://doi.org/10.1016/S0140-6736(23)01296-5
Srinibas Karmakar, Bhowmik, M., Laha, B., & Manna, S. (2023). Recent advancements on novel approaches of insulin delivery. Medicine in Novel Technology and Devices, 19, 100253–100253. https://doi.org/10.1016/j.medntd.2023.100253
Aloke, C., Egwu, C. O., Aja, P. M., Obasi, N. A., Chukwu, J., Akumadu, B. O., Ogbu, P. N., & Achilonu, I. (2022). Current Advances in the Management of Diabetes Mellitus. Biomedicines, 10(10), 2436. https://doi.org/10.3390/biomedicines10102436
Srinivasan, M., Thangaraj, S. R., & Arzoun, H. (2021). Gene Therapy - Can it Cure Type 1 Diabetes? Cureus, 13(12). https://doi.org/10.7759/cureus.20516
Sharma, G., Sharma, A. R., Nam, J.-S., Doss, G. P. C., Lee, S.-S., & Chakraborty, C. (2015). Nanoparticle based insulin delivery system: the next generation efficient therapy for Type 1 diabetes. Journal of Nanobiotechnology, 13(1). https://doi.org/10.1186/s12951-015-0136-y
Massarenti, L., Aniol-Nielsen, C., Enevold, C., Toft-Hansen, H., & Nielsen, C. H. (2022). Influence of Insulin Receptor Single Nucleotide Polymorphisms on Glycaemic Control and Formation of Anti-Insulin Antibodies in Diabetes Mellitus. International Journal of Molecular Sciences, 23(12), 6481. https://doi.org/10.3390/ijms23126481
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