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Wednesday, 30 April, 2025
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New review highlighs diabetes research, treatment advances

In a paper surveying advances in diabetes pathogenesis and treatment, and which explores the complex factors contributing to the onset and progression of the disease, the authors suggest that an understanding of these dynamics is key to developing targeted interventions to reduce the risk of developing diabetes and managing its complications.

In the review, published in a special 50th anniversary issue of the peer-reviewed journal Cell, the authors surveyed hundreds of studies that have emerged over the years looking at the causes underpinning types 1 (T1D) and 2 (T2D) diabetes and new treatments for the disease. They examine the role that genes, environmental factors, and social determinants of health play and diabetes' effect on cardiovascular and kidney disease.

News-Medical.net reports that what they found shows there are many advances in treatments that could stem the tide of a disease that has struck millions of people worldwide and which keeps growing.

In addition, some of these advances could be used to treat other disorders.

There are still challenges ahead, said Dr Dale Abel, lead author, and chair of the University of California-LA Department of Medicine, but the review “is an educational tool which will be the go-to reference for physicians and researchers, providing a state-of-the-art update of where the field is now, and where it is headed”.

Most people are affected by type 2 diabetes, for which inadequate diet and obesity are important underlying causes. Type 1 accounts for fewer than 5% of all cases.

As of 2021, about 529m people around the world were diagnosed with diabetes, representing about 6.1% of the global population, or about one in 16 people. Prevalence in some regions is as high as 12.3%. Type 2 diabetes comprises about 96% of cases, with more than half due to obesity.

Genetics, the central nervous system, and the interplay between various organs as well as social and environmental factors like food insecurity and air pollution, play a role in development of the condition.

But some recent discoveries represent significant strides toward managing and perhaps even reversing the disease. For instance, a 2019 study found that a 14-day course of the antibody teplizumab delayed the progression of type 1 diabetes from stage one to stage three by 24 months. A follow-up analysis in 2021 showed that the delay could be up to 32.5 months.

Based on these results, the US Food and Drug Administration approved teplizumab as the first disease-modifying therapy for type 1 diabetes, the researchers write.

Advances in insulins with optimised pharmacokinetics, algorithm-driven subcutaneous insulin pumps, continuous glucose monitoring, and improved tools for self-management, have significantly improved the quality of life and outcomes for people with stage three type 1 diabetes.

In addition, stem cells could replace insulin-producing cells that are lost in type 1 diabetes, Abel said.

For type 2 diabetes, three classes of glucose-lowering medicines that were introduced in the past 20 years – GLP1RAs (glucagon like peptide-1 receptor agonists), DPP-4 inhibitors, and SGLT-2 inhibitors – have enabled people to control their glucose levels without gaining weight and with a low risk of developing hypoglycaemia.

Personalised and precision medicine approaches are being explored to target the molecular mechanisms behind diabetes. However, they must demonstrate that benefits are clinically superior to standard care and are cost-effective. Also, it remains to be seen if precision approaches can be implemented in all settings worldwide, including those with few resources.

Combinations of GLP1Ras and with molecules that target other receptors, such as GIP, have shown even greater efficacy in treating diabetes. Recent trials have also shown they are very effective in treating obesity, certain types of heart failure and even sleep apnoea, in part because of their potency to induce weight loss and reduce inflammation. Clinical trials are now under way to test their efficacy in treating other disorders like Alzheimer’s disease, Abel said.

“Advances in therapy now raise the hope of preventing or curing T1D and treating T2D in ways that not only improve metabolic homeostasis, but also concretely reduce the risk and progression of cardio-renal disease,” the researchers write.

“Finally, as we understand and develop tools for discerning the underlying heterogeneity leading to diabetes and its complications, the stage will be set for targeting therapies and prevention strategies to optimise their impact, in ways that will be broadly applicable across diverse populations and availability of healthcare resources.”

 

Cell article – Diabetes mellitus—Progress and opportunities in the evolving epidemic (Open access)

 

News-Medical.net article – New review highlights advances in diabetes research and treatment (Open access)

 

See more from MedicalBrief archives:

 

Diabetes a leading killer in SA, but we don’t know how many have it

 

Tirzepatide effective for obstructive sleep apnoea – US study

 

STEP 2 trial: Semaglutide hope for patients with type 2 diabetes

 

SA stocks of diabetes drug drained after global weight loss frenzy

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