The latest on diabetes this year

Certainly the "diabetes cure" has not yet been found, nor is it expected to be anytime soon. But the scientific community with systematic medical research continues to make leaps aiming to offer diabetics a tomorrow with less burden on health.

Regarding type 1 (insulin-dependent Diabetes Mellitus) efforts are focused on creating new insulin-producing cells that will correct the lack of insulin in the body. More specifically, on the one hand, we are referring to islet transplantation, in which β-cells are obtained from donors and then injected into the diabetics, or on the other hand, to receiving stem cells from the diabetics themselves, after which these primordial cells differentiate and mature into insulin-producing β cells, which then they are re-injected into the diabetics themselves, enabling them to become independent of exogenous insulin administration. The stem cell technique is not accompanied by negative side effects since it does not require immunosuppressive treatment. Recently a research team announced the first diabetic with fully uncontrolled diabetes for about 50 years, who a few days after the administration of the stem cells was found to have normal blood sugars even after meals, with a free, unrestricted diet.

Regarding the prevention of type 1 diabetes, treatments (teplizumab) are being tested that delay its onset in people who belong to high-risk groups for its onset. Type 1 diabetes, which is most often seen in childhood and adolescence, occurs when the immune system destroys the cells that produce insulin and the aforementioned biological factors inhibit this process. In the early stages (3 to 6 months) of the natural course of the disease, it is estimated that about one in 10% of the insulin-producing cells are still functional, so inhibiting their autoimmune destruction will allow them to survive and continue to produce insulin for a few more years.

Technology in turn has evolved to such an extent that many devices have been established as absolutely necessary for the regulation of the diabetic syndrome. Artificial intelligence applications complement the efficient operation of these devices, such as continuous glucose recording sensors, insulin delivery pumps and closed circuits of the artificial or bionic pancreas. Technologically more advanced equipment is going to be released and made available this year to offer better services to the patient, even to children as young as 2 years old.

Next year, it is expected that insulin preparations in pill form will be released, so that its injection administration will cease. In fact, it is planned to either be administered in the form of a capsule or contained in a chocolate where special nanoparticles like a mantle will protect the insulin molecules so that they are not destroyed by gastric acid so that they can reach their final destination, the liver, where they will exercise their action. Studies have been successfully completed in monkeys and are soon to begin in humans. They are expected to be on the market in 3 years at most.

In the coming months, weekly basal insulin for the treatment of type 1 and type 2 diabetes will be available on the market. Basal insulin is currently given in one or two doses around the clock and this new insulin (Icodec) will be taken once a week. "Smart" insulins, which will only be active if sugar levels are high, will also be available soon. At normal low glucose levels, its molecules will remain deactivated and therefore the diabetic will not be at risk of hypoglycemia.

For Type 2 Diabetes, last year preparations with GLP-1 agonists such as semaglutide were very popular, which, in addition to their strong anti-diabetic effect, on the one hand protect against myocardial infarctions, and on the other lead to significant weight loss. This year, however, a new, stronger representative of this class of drugs is expected to be released with additional combined action against GIP (gastric inhibitory polypeptide).

From the moment of our birth, microbes develop in our intestines which are necessary for the completion of the digestion of food. However, it has been observed that many modifications of this microbial flora are associated with the appearance of chronic diseases and diabetes. However, a reversal of the diabetic syndrome has been reported when an enema was attempted, the enrichment of the gut of a diabetic patient with a microbiome from a non-diabetic person. This technique is called "faeces transplantation" and concerns both types of diabetes.

It is noted that many researchers consider Alzheimer's disease to be type 3 diabetes because its occurrence is associated with metabolic disorders of the diabetic syndrome and anoviral syndromes appear to be more common in diabetic individuals. The main pathophysiological feature observed in the onset of dementia is insulin resistance in brain cells which by the way do not use insulin as a regulator for their energy expenditure, but inflammatory processes and oxidative stress are observed. Although the scientific and health authorities have not adopted this new categorization, we know that the risk factors for the onset of Alzheimer's disease in addition to the genetic background include a diet rich in calories, carbohydrates and fats, reduced physical activity, hypertension and dyslipidemia.

The global market for anti-diabetic treatment is expected to exceed 120 billion. dollars in 2032 since, in addition to the aforementioned, many other innovative treatment options for diabetes and its complications will be studied that will certainly improve the lives of millions of patients worldwide.

The latest on diabetes this year (ieidiseis.gr)