What’s new in the treatment of diabetes?

Diabetes is an American epidemic. The Centers for Disease Control and Prevention (CDC) reports that just over 1 in 10 Americans — approximately 34.2 million — has diabetes, and it is estimated that 88 million adults in the U.S. have prediabetes. Many aren’t even aware of their condition.

Dr. Darius Schneider, a board-certified endocrinologist affiliated with Sharp Community Medical Group, explains that diabetes is a lifelong condition, and is caused when a person’s blood glucose levels become too high. There are three main types of diabetes:

• Type 1 diabetes occurs when the body’s immune system attacks and destroys the cells that produce insulin.
   

• Type 2 diabetes occurs when the body’s cells do not react to insulin — known as insulin resistance — often in the context of obesity, but not always.
   

• Gestational diabetes sometimes occurs during pregnancy, when women develop very high levels of blood glucose, and the body is unable to produce enough insulin to metabolize it.

Other rare types of diabetes include maturity-onset diabetes of the young (MODY), which develops in adolescents, but acts more like adult Type 2 diabetes; latent autoimmune diabetes in adults (LADA), a slow-progressing form of autoimmune diabetes; and pancreatic diabetes.

According to Dr. Schneider, what all types of diabetes have in common is the high level of blood glucose. This results in a subsequent “spillage of glucose into the urine,” he says.

In fact, diabetes means “sweet urine,” stemming from a widespread diagnostic method known as “urine tasting,” which was used in ancient Greece and Egypt. Proof, Dr. Schneider says, that diabetes has been around for a very long time and remains a serious health concern.

“We see an increase in both main types of diabetes, Type 1 and Type 2,” Dr. Schneider says. “The increase in the numbers of people living with Type 2 is likely linked to the obesity epidemic. For Type 1 diabetes, there is no exact answer as to why we are seeing an increase. Though one hypothesis involves viral infections.”

The additional risks of diabetes
Continuously high blood glucose levels have a toxic effect on cells and tissues, especially on the cells that make up small blood vessels found in the brain, eyes, kidneys, nerves and heart. This can lead to a functional impairment of those vessels, known as microvascular disease, putting those living with diabetes at risk for a variety of additional health concerns, including.

• Infections

• Stroke

• Diabetic kidney disease

• Diabetic eye disease

• Diabetic neuropathy — a type of nerve damage that can cause pain and numbness

“Small blood vessel injury leads to impaired blood flow to the tissues,” Dr. Schneider says. “And high glucose levels lead to immune cell dysfunction, making for impaired wound healing.”

According to Dr. Schneider, this is an area of intense and exciting exploration. He participated in research that discovered that certain sugar end products — or advanced glycation end products (AGEs) — that accumulate in people with diabetes serve as anchors for bacteria to enter the tissue, thus explaining why people with diabetes are prone to more frequent and more severe infections.

Effective diabetes monitoring is key
To effectively monitor and treat diabetes — both crucial due to the severity of illness it can cause — the finger-stick test remains the gold standard in blood glucose monitoring, Dr. Schneider says. However, continuous glucose monitors (CGM) are gaining in popularity.

A CGM is a small, skin-attached device that is automatically checking glucose levels every few minutes and transmitting the values to a receiver. It is made up of a sensor — a small needle-like device that is inserted through the skin and senses how much glucose is in the fluid under the skin — and a transmitter, which sends results to a receiver or mobile phone.

CGM data can also be transmitted directly to an insulin pump, where it is used for insulin dosing. When this happens automatically, it is called a closed-loop system.

“People with diabetes using this fascinating technology sometimes call themselves ‘loopers,’” Dr. Schneider says. “CGMs have been repeatedly proven to improve diabetes control tremendously. They are truly game changers for so many people living with the disease.”

Finding solutions to daily challenges related to diabetes
However, experts have learned to acknowledge the immense burdens people with the disease endure. According to Dr. Schneider, they now invest more time trying to help their patients tackle their daily challenges.

Some of these challenges include:

• The discipline required to manage diabetes — “What people without diabetes take for granted is a constant effort for people living with diabetes,” Dr. Schneider says.

• Access to care and drug prices — “U.S. prices for insulin, which is necessary for the bare survival for those living with disease, have skyrocketed and have seen a 200% to 300% increase in the past years,” he says.

• The lack of access to healthy food — “In the U.S., healthy food choices can be very expensive and are oftentimes out of reach,” Dr. Schneider says.

Therefore, research on the disease, as well as new and improved treatments, is ongoing. According to Dr. Schneider, new treatment options for Type 1 diabetes include extremely fast-acting insulins, slow-acting insulins and fully automated insulin pumps that can communicate with CGMs to create an “artificial pancreas.”

“We’ve also seen extremely exciting studies for the treatment of Type 1 diabetes with transplantation of stem cell-derived insulin-producing cells, as well as major breakthroughs in approaches to prevent Type 1 diabetes,” he says. “There is a better understanding about the impact of diet and exercise, and about ways to successfully implement behavioral changes.”

While Dr. Schneider is concerned about increasing sedentary lifestyle and weight issues, which have a general negative impact on health, he also sees a positive shift among some people.

“We see a trend of people becoming more health-conscious and wanting to feel empowered — to take on the challenge of living with diabetes,” Dr. Schneider says. “I have never seen so many people in my practice who come in because they want to do whatever it takes to reverse diabetes.”

Dr. Schneider says that it is important to acknowledge and honor these efforts. “Successful stories do exist in the challenging environment of diabetes,” he says.