Diabetes - On the horizon

Risk factors

What are they?

There are many known factors that increase the likelihood of diabetes. Better understanding of the condition over time will help identification of additional risk factors.

What is the aim?

Scientists hope that the discovery of novel risk factors will enable healthcare professionals to improve diabetes prevention, diagnosisThe process of determining which condition a patient may have. and treatment.

How do they work?

Genetic factors contribute to the development of both type 1 and type 2 diabetes. While other established risk factors for type 2 diabetes include obesityExcess accumulation of fat in the body. and ethnicity, the risk factors for type 1 diabetes are less well established.

In June 2009 scientists in the UK suggested virusesMicrobes that are only able to multiply within living cells. that cause diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. and vomiting may trigger diabetes. They looked at the pancreases of 72 children who had died after being diagnosed with type 1 diabetes, and found evidence of virusesMicrobes that are only able to multiply within living cells. known as group B coxsackieviruses (CVB) in more than 60 per cent of them.

A 2008 report in the journal Diabetologia found children born by Caesarean section had a 20 per cent higher risk of developing type 1 diabetes than those born naturally.

Mounting evidence suggests the amount of sleep people get may play a role in the development of type 2 diabetes. In the USA researchers found people who slept fewer than six hours a night were more likely to develop a condition that precedes diabetes. Others found taking regular lunchtime naps may increase the risk of developing type 2 diabetes.

What stage of development has been reached?

More research is needed to establish the role of these factors in the development of diabetes.

Gene therapy to prevent or cure diabetes

What is it?

Gene therapy is a technique that aims to correct the faulty genes that cause disease.

What is the aim?

Scientists hope to identify the culprit genes for diabetes, and to replace them with healthy versions to prevent diabetes or cure the condition.

How does it work?

Healthy DNAThe building blocks of the genes in almost all living organisms - spelt out in full as deoxyribonucleic acid. can be inserted into cells to make sure they work properly.

Who is it for?

People with type 1 diabetes. In theory, geneThe basic unit of genetic material carried on chromosomes. therapy could even be used for embryos before they were implanted into the womb during in vitro fertilisationFertilisation of the female reproductive cell (ovum) outside the body, before implantation into the uterus (womb). Abbreviated to IVF. (IVFIn vitro fertilisation. Fertilisation of the female reproductive cell (ovum) outside the body, before implantation into the uterus (womb).) treatment to make them free of the condition.

What stage of development has it reached?

Researchers are identifying genes that affect diabetes risk. An international research consortium has identified four new geneticRelating to the genes, the basic units of genetic material. regions that influence the risk for type 1 diabetes. Scientists have been able to cure mice of diabetes using experimental geneThe basic unit of genetic material carried on chromosomes. therapy. Whether this approach will work in humans remains to be determined, however.

Early identification and screening

What is it?

Experts are looking for ways to spot diabetes in its earliest stages, long before the symptoms develop.

What is the aim?

If diabetes can be detected early, there may be ways to slow or block the condition's progression.

How does it work?

Early markers of disease might include faulty genes linked with diabetes and autoantibodies, which are proteins that suggest self-destruction is occurring.

Who is it for?

People with type 1 and type 2 diabetes.

What stage of development has it reached?

In 2007 researchers in the USA identified a fourth autoantibody for type 1 diabetes. When all four autoantibodies are measured in combination, they raise detection rates for autoimmunity to 98 per cent at the early stages of the condition.

In 2009 other researchers found an inflammatory factor called CXCL10 that may be useful as an early warning sign of diabetes.

Vaccines to prevent diabetes

What are they?

Vaccines help to develop the body's defence against diseases.

What is the aim?

Although the exact cause of type 1 diabetes is unknown, the body's defence system is thought to be involved, mounting an abnormal attack on its own cells that leads to the destruction of the cells in the pancreas that make insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. The aim is to prevent this so-called autoimmuneAny condition caused by the body’s immune response against its own tissues. attack.

How do they work?

A vaccine would encourage the production of protective immune cells to defend the beta cellsThe cells of the pancreas where insulin is produced. of the pancreas against attack.

Who is it for?

People with type 1 diabetes.

What stage of development has it reached?

There are several types of vaccines in various phases of development, but a viableCapable of survival. vaccine is still years away.

The Juvenile Diabetes Research Foundation is collaborating with MediGene over two years to carry out very early tests on monoclonal T cellThe basic unit of all living organisms. receptor (mTCR) therapeutics. Their vaccine works by binding to the beta cellsThe cells of the pancreas where insulin is produced. of the pancreas, which produce insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., and shielding them from destruction by other immune cells.

Pharmaceutical companies are also working to develop anti-CD3 antibodiesSpecial proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. for the treatment of early-stage type 1 diabetes. This works in a similar way to mTCR but targets the immune cells that do the destroying rather than the beta cellsThe cells of the pancreas where insulin is produced. that are destroyed.

Researchers who have linked a common gastric infectionInvasion by organisms that may be harmful, for example bacteria or parasites. with the development of type 1 diabetes believe they could create a vaccine against the virusA microbe that is only able to multiply within living cells..

Artificial pancreas

What is it?

A computerised system that can take over the job of the pancreas to regulate bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar.

What is the aim?

To help people with diabetes automatically control their bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. level without the need for repeated jabs to test the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels and to give insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

How does it work?

People can already wear continuous glucoseA simple sugar that is an important source of energy in the body. monitors to measure bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. and insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. pumps to deliver insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. The devices do not communicate with one another, however, and so patients must manually read sugar levels and operate the pump.

The artificial pancreas overcomes this by coupling the continuous glucoseA simple sugar that is an important source of energy in the body. sensor, which sits under the skin, with the insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. pump. The sensor measures bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels on a minute-by-minute basis and sends the information to a monitor. A computer program then works out the right dose of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., which is delivered via the insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. pump.

Who is it for?

People with type 1 diabetes and those with type 2 diabetes who need insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

What stage of development has it reached?

Researchers working on an artificial pancreas believe they are just a few years away from bringing a wireless device to the market.

Prevention and treatment of complications associated with diabetes

What is the background?

Diabetes is associated with numerous long-term complications, particularly when bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar is not tightly controlled.

What is the aim?

Scientists are searching for ways to prevent and treat complications such as eye, nerveBundle of fibres that carries information in the form of electrical impulses. and kidney damage.

Who is it for?

People with type 1 and type 2 diabetes.

What stage of development has it reached?

There are many strands of research at various stages. In the USA researchers at Johns Hopkins University have shown that an injection of an antibodyOne of a group of special proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. directed at vascular endothelial growth factorA chemical that stimulates new cell growth and maintenance in the body. can treat a form of diabetic eye disease called macular oedemaThe accumulation of excess fluid in the tissues of the body.. This antibodyOne of a group of special proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. is already approved for the treatment of a non-diabetes eye disease in the US.

Meanwhile, pharmaceutical companies Pfizer and TransTech Pharma have reached a licensing agreement to develop and market drugs targeting a molecule called RAGE, which has been linked to various diabetic complications.

Other researchers have found type 1 diabetes patients carrying a version of the DRB1 geneThe basic unit of genetic material carried on chromosomes. are half as likely to have diabetic kidney disease, regardless of how long they have had diabetes. This geneThe basic unit of genetic material carried on chromosomes. may provide a target for the prevention or treatment of kidney disease in diabetes.

For patients with type 2 diabetes, a combination of two bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-pressure-lowering drugs, the angiotensin-converting enzymeA protein that speeds up chemical reactions in the body without being used up itself. (ACE) inhibitor perindopril and the diuretic drug indapamide, appears to cut the risk of kidney disease, even in patients who do not have high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure.

Researchers have discovered that people with type 1 and type 2 diabetes have a reduced level of vitamin B1 or thiamine. In a recent clinical trial in people with type 2 diabetes, correcting thiamine deficiencies reversed early-stage kidney disease.

Stem cell therapy to repair the pancreas

What is it?

Stem cells are cells with the ability to become any type of cellThe basic unit of all living organisms. in the body, including insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.-producing cells in the pancreas. Scientists believe that stem cellThe basic unit of all living organisms. therapy may provide treatment and even a cure for diabetes.

How does it work?

Stem cells could be used as a self-repair kit for the body. The hope is to restore the ability of the pancreas to produce insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

Who is it for?

Patients with type 1 diabetes and those with type 2 diabetes who need insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

What stage of development has it reached?

Many scientists are racing to find a stem cellThe basic unit of all living organisms. cure. All are still at the trial stage and experts say it will be at least a decade before doctors can use the technology routinely.

In the UK a team from the University of Manchester, working with experts at the University of Sheffield, have been researching a protein: the transcription factor PAX4. They found that this protein increased the proportion of embryonic stem cells that developed into pancreaticRelating to the pancreas. beta cellsThe cells of the pancreas where insulin is produced.. These cells have the potential to produce insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. when transplanted into the body.

Scientists in Brazil and the USA have used transfusions of patients' own stem cells to reverse type 1 diabetes. One patient was able to survive without insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. injections for 35 months, and four others for at least 21 months.

Transplantation of the pancreas or islet cells

What is it?

Patients can be given a whole pancreas from a dead donor, a portion of a pancreas from a living relative or a transplant of just the islet cells that make insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. The islet cells could even come from animals because the supply of human islets is severely limited. Some patients with diabetes may also need a kidney transplant if their condition has badly damaged their kidneys.

What is the aim?

The ultimate aim is to help people with diabetes live without daily injections of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

How does it work?

The idea is to replace the poorly functioning organ with one that works well.

Who is it for?

Transplants are for people with type 1 diabetes who are unable to make enough insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

What stage of development has it reached?

Islet cellThe basic unit of all living organisms. transplants remain an experimental therapy. To date, one patient was able to come off insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. completely. The drugs required to prevent rejection of the transplant can have serious side effects, however. This means the procedure is currently only suitable for people who have extreme problems controlling their diabetes.

Regeneration of the pancreas

What is it?

Researchers believe it is possible to get the pancreas to repair itself by growing back the insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.-producing beta cellsThe cells of the pancreas where insulin is produced. in people who have type 1 diabetes, as opposed to transplanting cells from organ donors or other sources.

What is the aim?

To free patients of the need to make daily insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. injections and, ultimately, to cure diabetes.

How does it work?

The procedure involves triggering the body to grow its own insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.-producing cells, either by copying existing cells - no matter how scarce - or causing the pancreas to grow new ones.

Who is it for?

Predominantly people with type 1 diabetes, but it may also help some with type 2 diabetes.

What stage of development has it reached?

An exploratory Phase IIa clinical trial is underway of a combination treatment called E1-I.N.T. that contains gastrin and epidermal growth factorA chemical that stimulates new cell growth and maintenance in the body., which is being developed for the regeneration of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.-producing beta cellsThe cells of the pancreas where insulin is produced.. In both type 1 and type 2 diabetes early trials, patients showed improvements in important measures of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. control.

A biopharmaceutical company in Germany is testing drugs to activate a geneThe basic unit of genetic material carried on chromosomes. that regulates beta cellThe basic unit of all living organisms. development.

Blood monitoring alternatives

What are they?

Scientists are looking for better ways for patients to check and control their bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels. Tight control of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels is important to avoid disease complications.

What is the aim?

Ideally, any new bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. monitoring technique would be non-invasiveAny test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. , avoiding the need for the finger prick test. Reliable, continuous bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. monitoring is the ultimate aim.

How do they work?

Researchers are investigating several non-invasiveAny test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. strategies including the use of new infrared spectroscopy or implantable sensors. These do not measure bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. directly, but instead measure glucoseA simple sugar that is an important source of energy in the body. in the tissues or the skin to give a relatively accurate reflection of what is going on in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid..

Who are they for?

Patients with type 1 and type 2 diabetes.

What stage of development have they reached?

Devices that have been approved in many countries including the USA and the UK are the GlucoWatch Biographer and the MiniMed Continuous Glucose Monitoring System. The GlucoWatch Biographer measures slight chemical reactions on the surface of the skin. The MiniMed Continuous Glucose Monitoring System is a device that is implanted under the skin and takes bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar readings every five minutes for up to three days.

Although available, the devices are still relatively experimental. Experts are confident, however, that continued improvements in monitoring research should result in effective solutions in the next five years.

Meanwhile, in the USA researchers from the University of Missouri believe it may be possible to analyse breath or urine samples for a diabetes marker using an optical gas sensor. This device carries out a detailed analysis of molecules in gas vapour. Evidence from a small study in the USA suggests that the breath of people with diabetes contains an organic compound, called methyl nitrateOne of a class of drugs that dilate the blood vessels., which accurately reflects bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels.

Needle-free insulin delivery

What is it?

Researchers continue to work on needle-free insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. delivery systems that would be easier to use and would eliminate the need for injections.

How does it work?

Researchers are investigating several approaches including implantable insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. pumps, oral insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. tablets, inhaled insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. sprays and insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. delivered through the skin using patches.

Who is it for?

The technology could help patients with type 1 diabetes and those with type 2 diabetes who need insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., and particularly those with needle phobias.

What stage of development has it reached?

Large clinical trials have tested insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. pumps that are surgically implanted under the skin, usually into the wall of the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs., and programmed to deliver insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. into the abdominal cavityThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. or a large vein. This would more accurately mimic the way insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. is released in a healthy person. These devices are close to becoming more widely available.

Researchers have been looking at ways to deliver insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. orally and overcome the problem of it being destroyed by the stomach's digestive juices. In animal studies, a polymer-coated oral insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. has had some success. The polymer gel protects the insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. until it reaches the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus., where it can be absorbed. More studies are needed before human trials can begin, however.

Scientists are also working on an insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. skin patch. Animal studies have shown promise, but in humans the patches can so far provide only low insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. doses, meaning the patient still needs to take extra insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

An inhalable insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., called Exubera, was launched in 2006 but was taken off the market after it failed to catch on for commercial reasons. However, scientists are still exploring this possibility.

Others are testing insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. nasal and throat sprays that are absorbed through the nasal passages or the lining of the mouth, respectively. One throat spray, called Oral-lyn, from Generex, was approved in 2005 for clinical use in people with type 2 diabetes in Ecuador. The company hopes to gain similar approval for use in the USA and Europe.

New medications

What are they?

Scientists want to expand the number of medications available to fight both types of diabetes.

Who are they for?

People with type 1 or type 2 diabetes.

What is the aim?

Some experimental drugs are aimed at curing diabetes, while others are being designed to treat the condition or to prevent diabetes-related complications.

What stage of development has it reached?

Four new pharmaceutical classes on the horizon for treating high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. include sodium-glucoseA simple sugar that is an important source of energy in the body. co-transporter inhibitors, glucokinase activators, glucagonA hormone produced by the pancreas that broadly opposes the actions of insulin and so increases the blood sugar (glucose) level. receptor antagonists and sirtuins:

  • Sodium-glucoseA simple sugar that is an important source of energy in the body. co-transporter inhibitors act on the kidneys so that excess sugar passes directly into the urine
  • Glucokinase activators increase insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. production by the pancreas and would also lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. by increasing glucoseA simple sugar that is an important source of energy in the body. uptake by the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats.
  • Glucagon receptor antagonists block the work of glucagonA hormone produced by the pancreas that broadly opposes the actions of insulin and so increases the blood sugar (glucose) level., a hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. that increases bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body.
  • Sirtuins are proteins that play many roles and are believed to have an anti-ageing effect. Resveratrol, a chemical found in red wine, is a sirtuin activator. Some preliminary studies have shown that sirtuin activators may help lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. in people with type 2 diabetes. Further studies are needed, however.