An insightful new paper reviews recent developments in understanding diabetes causes and treatments, highlighting the intricate elements that influence the disease’s emergence and progression. This knowledge is essential for creating targeted strategies aimed at lowering diabetes risk and handling its complications.
In a paper released on July 25 as part of a special edition celebrating the 50th anniversary of the journal Cell, the authors examined a wealth of studies that have explored the origins of both type 1 (T1D) and type 2 (T2D) diabetes, as well as new ways to treat the condition. They discuss the impact of genetics, environmental influences, and socio-economic factors on diabetes, along with its relation to cardiovascular and kidney diseases.
The findings indicate promising treatment advancements that could help combat a disease affecting millions globally. Moreover, certain treatments could also apply to other health issues. However, obstacles still remain.
“With the increasing rates of diabetes globally, it is crucial to stay updated on the latest research so healthcare providers can offer optimal patient care, and patients can make well-informed health choices,” stated Dr. E. Dale Abel, the lead author and chair of the UCLA Department of Medicine. “This resource merges the latest findings and trends in diabetes management, potentially impacting clinical practice as more individuals face diabetes.
“This review will serve as a primary resource for physicians and researchers, providing an up-to-date perspective on the current state and future direction of the field,” Abel added.
Type 2 diabetes predominantly affects people, often linked to poor diet and obesity, while type 1 diabetes makes up less than 5% of cases. As of 2021, around 529 million people worldwide had been diagnosed with diabetes, accounting for roughly 6.1% of the global population, or one in 16 individuals. In some areas, prevalence reached as high as 12.3%. About 96% of diabetes cases are type 2, with over half attributed to obesity. Projections estimate that by 2050, approximately 1.31 billion people will have diabetes, with prevalence potentially rising to 16.8% in North Africa and the Middle East and 11.3% in Latin America and the Caribbean, according to the researchers.
Factors including genetics, the central nervous system, and the interaction among various organs, along with social and environmental elements like food insecurity and air pollution, contribute to diabetes development.
Recent discoveries mark notable progress towards managing or possibly reversing diabetes. For example, a 2019 study demonstrated that a 14-day treatment with the antibody teplizumab could delay the advancement of type 1 diabetes from stage 1 to stage 3 by 24 months, with a 2021 follow-up revealing a potential delay of up to 32.5 months.
Following these results, the U.S. Food and Drug Administration authorized teplizumab as the first therapy to modify the progression of type 1 diabetes, as noted by the researchers.
Innovative insulins featuring improved pharmacokinetics, smart subcutaneous insulin pumps, continuous glucose monitoring, and enhanced self-management tools have significantly elevated the quality of life and outcomes for individuals with stage 3 type 1 diabetes.
Additionally, stem cells may potentially restore insulin-producing cells lost in type 1 diabetes, according to Abel.
For type 2 diabetes, three classes of glucose-lowering drugs introduced in the past two decades—GLP1RAs (glucagon-like peptide-1 receptor agonists), DPP-4 inhibitors, and SGLT-2 inhibitors—have empowered individuals to manage their glucose levels effectively without weight gain or a high risk of hypoglycemia. Efforts are ongoing to explore personalized medicine strategies that address the underlying molecular mechanisms driving diabetes. However, these methods need to prove they offer clear clinical advantages over standard treatments and are economically viable. The feasibility of applying precision strategies universally, especially in resource-limited settings, is still uncertain.
Combining GLP1RAs with agents targeting other receptors, such as GIP, has shown even greater effectiveness in diabetes care. Recent trials have also indicated their efficacy in addressing obesity, certain heart failure types, and even sleep apnea, partly due to their strong potential to induce weight loss and lower inflammation. Clinical trials are currently underway to assess their effectiveness in treating other conditions like Alzheimer’s disease, said Abel.
“These therapeutic advancements foster optimism for the prevention or healing of T1D and innovative approaches to treat T2D, not just in terms of metabolic balance but also in significantly lowering the risk and progression of cardiovascular and kidney diseases,” the researchers noted. “Understanding and identifying the diverse factors that lead to diabetes and its complications will pave the way for targeted treatments and preventive strategies, maximizing their effectiveness across various populations and levels of healthcare access.”
Additional co-authors include Anna Gloyn from Stanford University, Carmella Evans-Molina from Indiana University, Joshua Joseph from The Ohio State University, Shivani Misra from Imperial College London, Utpal Pajvani from Columbia University, Judith Simcox from the University of Wisconsin-Madison, Katalin Susztak from the University of Pennsylvania, and Daniel Drucker from the University of Toronto.
The research of the authors has been backed by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK127236, U01DK127786, U01DK127382, R01DK127308, R01DK133881, UC4DK104166, P30DK097512, UM1DK126185, U01DK123743, U24DK098085, P30DK11607406, R01DK132403, AHRQ R01HS028822, DK103818, DK119767, R01DK133479), National Heart, Lung, and Blood Institute (RO1DK125079, R61HL141783), American Heart Association (20SFRN35120123, 23SFRNCCS1052486, 23SFRNPCS1067039, 24FIM1266846), U.S. Department of Veterans Affairs Merit Award (I01BX001733), Wellcome Trust (095101, 200837), Wellcome Trust Career Development Award (223024/Z/21/Z), Glenn Foundation, American Federation for Aging Research (A22068); Hatch Grant (WIS04000-1024796); JDRF (JDRF201309442); Canadian Institutes of Health Research (154321), a BBDC-Novo Nordisk Chair in Incretin Biology, and Sinai Health-Novo Nordisk Fund in Regulatory Peptides.
