Advances in diabetes diagnosis, monitoring and therapies

The 14^th of November marks World Diabetes Day so it’s apt to note the number of sufferers is increasing at an alarming rate. Globally, around 415 million people are diabetic — nearly half of which are undiagnosed. Diabetes treatment costs have peaked at £1bn/year in the UK; in the US they are more than $320 billion/year.

Type 1 and Type 2 diabetes: what’s the difference?

Type 1 diabetes occurs when the body's immune system attacks and destroys the cells in the pancreas that produce insulin. It affects around 10% of sufferers and is not related to diet and exercise.

Type 2 diabetes, on the other hand, affects most patients (around 90%) and is linked to poor diet and lack of exercise, as well as family history. Whilst the pancreas still produces insulin, the body doesn’t use it as effectively as it should, developing insulin resistance.

Whilst type 1 symptoms develop quickly because the body doesn’t produce insulin at all, it can take years for type 2 symptoms to appear meaning that those with the condition can go decades without a diagnosis.

Misdiagnosis of type 1 diabetes as type 2 is also a problem, especially amongst those over 30. Type 1 has historically been seen as a condition which develops in children and teenagers, leading it to be mislabelled as “juvenile diabetes”.

With the number of diabetes sufferers predicted to rise to over 640 million by 2040, what are the current advances in diagnosis and treatment?

Spotting the warning signs years in advance

With type 2 diabetes, early detection is key to avoid long-term health issues such as blindness, amputation and stroke.

A Japanese study observed 27,000 non-diabetics between 2005 and 2016, during which 1,067 cases of type 2 diabetes were diagnosed. The researchers discovered that all of the participants who became diabetic had increased fasting blood sugar levels and insulin resistance, along with higher BMIs, up to 10 years before diagnosis.

This was also the case with those who were diagnosed as pre-diabetic, albeit to a lesser degree, suggesting that the warning signs could potentially be detected as much as 20 years before diagnosis. This would allow individuals to reduce their risk of developing the disease by improving their diet and level of exercise.

From finger pricks to connected devices

Improved detection is a great start, but monitoring the condition can be tricky, with the onus on the patient to monitor their own blood glucose levels with finger prick blood tests.

Continuous glucose monitoring (CGM) devices are finally becoming available. These are small devices which sit under the skin, continuously measuring the amount of glucose present in the body’s interstitial fluid. They can also alert the user when levels are above or below critical values. The devices still require finger prick tests twice a day to calibrate them but significantly reduce the burden on the patient.

The latest technology is the Flash glucose monitor. It works in a similar way to other CGM devices, measuring the glucose levels in the interstitial fluid under the skin. Where it differs is that the user only gets readings when they scan the sensor as opposed to continuously. The Flash can be worn for longer (14 days rather than 7 for CGM devices) and every time the user scans the monitor, they can access the previous 8 hours’ readings as well as the current one to help identify trends.

CGM devices are not currently available to everyone on prescription, although Diabetes UK’s #FightForFlash campaign has seen over 65% of areas in the UK offer the flash monitoring system on prescription and the charity is pushing for full coverage.

Life-changing therapies

With the advent of new diagnostic and monitoring devices, diabetes researchers are also searching for better treatments and even exploring the possibility of potential cures.

The development of an “artificial” pancreas, or closed loop insulin delivery system, has gained pace in recent years. This system monitors blood sugar levels and administers the correct dose of insulin to the user, potentially replacing the current method of manually injecting insulin via a pump.

Medtronic gained FDA approval in 2016 for its MiniMed® 670G system, the first Hybrid Closed Loop insulin delivery system approved anywhere in the world. Bigfoot Biomedical recently raised $37m in order to fund a clinical trial of their automated insulin infusion device, which is currently ongoing.

With projects such as these in the pipeline, the next few years may well see artificial pancreas technology become widely available.

A Dutch study unearthed a potential game-changer when an hour-long procedure, trialled in 50 patients with type 2 diabetes, burned away the mucous membrane of the small intestine causing a new membrane to develop within two weeks. This procedure caused blood sugar levels to stabilise, with 90% of participants still seeing normal levels a year later. This may add weight to the theory that there is link between nutrient absorption by the mucous membrane in the small intestine and the onset of insulin resistance in people with type 2 diabetes. If this is the case, then this innovative (yet invasive) potential new treatment may make insulin pumps a thing of the past.

Aside from the disease itself, researchers have been looking at ways to combat the health issues caused by diabetes. One of the most devastating is diabetic retinopathy — damage caused by high sugar levels in the blood vessels in the eye. Diabetes is the leading cause of preventable sight loss. However, thanks to research conducted on behalf of Diabetes UK, all diabetes patients now have access to annual sight tests on the NHS.

Researchers at Queen’s University Belfast are tackling retinopathy through non-invasive imaging, looking specifically at how the blood vessels in the retina change. If successful, this will help with earlier diagnosis and treatment, as well as being a safer and quicker detection method than those currently available.

Another study at the University is developing new therapies using existing cancer and inflammation therapies to prevent diabetes-related blood vessel leakage in the back of the eye.

Recruitment needs

Biostatisticians, device developers, hardware engineers, medical advisers and medical writers are the roles currently in highest demand. With implantable and connected devices on the rise, we predict that software engineers and machine learning experts are going to be the most sought after over the coming years.

These roles can lead to earlier diagnosis of the disease, enabling patients to monitor and control their health and ensure that the predicted figure of 640 million sufferers by 2040 is wildly off.