15 Breakthroughs That Could Beat Diabetes for Good
Smarter drugs. Healthy changes that really work. A bionic pancreas that acts like the real thing. Weight-loss surgery. (Plus cheaper insulin, gut bugs, broccoli that beats high blood sugar and more.) Here's the latest on the scientific advances with the potential to prevent diabetes—and make living with it easier than ever.
A research-proven way to slash risk
Big news for the 84 million Americans with prediabetes: The Diabetes Prevention Program—available at hundreds of YMCAs, hospitals, health centers, churches, work sites, and other locations across the country—could slash your risk for type 2 diabetes by 58 percent over three years. It’s based on a landmark 2002 study that tracked 3,234 overweight people with prediabetes. Those who exercised more, ate better, and lost 7 percent of their weight got bigger benefits than people who took a diabetes drug. Soon, Medicare will cover it, too.
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A diabetes drug that can prevent the disease
The nation’s most widely used type 2 diabetes drug—metformin—is cheap: Generic versions cost as little as $4 (some pharmacies give away samples). Plus, it’s safe. And while the drug is not yet approved by the U.S. Food and Drug Administration for prediabetes, research suggests it may be an alternative for people who can’t make the lifestyle changes to lower their risk of developing the disease. Metformin reduces blood sugar by boosting insulin sensitivity and depressing the amount of sugar the liver produces. A 2017 Georgetown University review showed that it cuts the risk of developing type 2 diabetes by 18 percent over 15 years.
Metabolic surgery can reverse diabetes
You might know it as weight-loss surgery, but rerouting the digestive system with gastric-bypass surgery (reducing stomach size and bypassing part of the small intestine) or with a sleeve gastrectomy (shrinking the stomach by about 80 percent) is a drastic step. But a landmark Cleveland Clinic study that tracked 150 women and men with type 2 diabetes for five years found the procedures make a difference. Two-thirds of the volunteers had metabolic surgery; the other third received intensive medical therapy, including weight-loss counseling, regular blood sugar checks, and diabetes medications. After five years, 45 percent of those who had gastric bypass and 25 percent who had a sleeve gastrectomy were off all diabetes drugs. In contrast, nobody in the medical-therapy group was medication-free.
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Metabolic surgery, part 2: Don’t wait
“People who have [weight-loss] surgery within five years of their diagnosis with type 2 diabetes have a 70 to 75 percent chance of a complete remission,” says Philip R. Schauer, MD, a professor of surgery at the Cleveland Clinic Lerner College of Medicine and director of the Cleveland Clinic Bariatric and Metabolic Institute. Schauer led a landmark study tracking metabolic surgery results in people with diabetes. “Even those who don’t achieve remission are doing better than before. Long-term blood sugar control is much better, which reduces the risk for horrible complications like blindness, kidney disease, heart attack, and stroke.”
Metabolic surgery, part 3: You don’t have to be severely obese to benefit
In 2016, the American Diabetes Association joined more than 45 medical organizations in endorsing surgery for people with moderate to severe obesity and diabetes. The organization even said it’s an option for those with mild obesity whose diabetes is not well controlled by medications. Philip R. Schauer, MD, director of the Cleveland Clinic Bariatric and Metabolic Institute, is quick to add that the first steps in battling diabetes should be lifestyle changes, followed by medications as needed. “If that doesn’t work, consider surgery,” he says. “Don’t wait years to do it. The consequences of poorly controlled diabetes are just too great.”
Up to 43 percent of people with diabetes now take two or more diabetes drugs, according to a recent international study of the medical treatments of 70,657 people with type 2. In the past five years alone, the FDA approved a dozen new combination drugs. The benefits? Combining two drugs in one pill is convenient. And tackling diabetes by several different biochemical routes helps some people gain better blood sugar control while reducing side effects—because the dose of each drug in the combo may be lower than if they took one drug alone.
Double-duty drugs, part two: Stopping heart disease
Another double-drug trend showing promise: Diabetes drugs that protect your heart. In 2016 and 2017, the FDA approved new labels for the diabetes drugs liraglutide (Victoza) and empagliflozin (Jardiance), touting their ability to reduce heart attacks, strokes, and deaths by up to 13 percent. Since about 70 percent of people with type 2 diabetes die from heart disease, this is a lifesaving benefit.
In the human body, cells in your pancreas monitor blood sugar levels and release the hormone insulin as needed. In Type 1 diabetes, these cells die out. In Type 2, these cells can’t keep up with the body’s insulin needs. One solution on the horizon: A “bionic,” artificial pancreas that automatically senses blood sugar and delivers the right amount of insulin. Four promising artificial pancreas systems received major funding from the National Institutes of Health in 2017, a sign of how important these devices could be for people with diabetes and their families.
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Replacing insulin-producing cells
Although islet cell transplants are commercially available in many countries (including Canada, the United Kingdom, and Australia), the procedure is still experimental in the United States due to concerns about effectiveness and about the short supply of human islet cells available for transplant. Researchers at the University of Miami and elsewhere are at work on new ways to transplant the cells so that they live longer—and won’t require patients to take immune-suppressing drugs for the rest of their lives. In a recent study of 48 people with type 1 diabetes who received islet cell transplants, 52 percent had healthy blood sugar levels one year later without insulin. If you’re concerned about blood sugar levels, make sure you know the best and worst diabetic drinks.
Insulin gets cheaper
Almost all the insulin used in the United States is produced by just three companies, and they regularly tweak their formulas to extend the amount of time their versions are under patent protection. The result is that the cost of insulin tripled between 2002 and 2013, according to the American Diabetes Association. As patents expire, copies of brand-name insulins are hitting the market at prices 15 to 28 percent lower. The first FDA-approved copycat insulin, called Basaglar, went on sale in the United States in 2016. Others are expected to follow soon.
A vaccine for type 1 diabetes?
Human clinical trials of a vaccine aimed at preventing infection with the Coxsackievirus B1 are set to begin in 2018 in Finland. Led by researchers from the University of Tampere, the goal is to reduce the risk for type 1 diabetes, in which insulin-producing cells in the pancreas are destroyed by the body’s own immune defenses. The vaccine takes aim at Coxsackie, which can trigger the harmful immune-system reaction.
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Mom was right: Broccoli’s great. Now, scientists from Sweden’s University of Gothenburg are extracting a compound called sulforaphane from this veggie and giving it to people with type 2 diabetes. In a 12-week study, it reduced blood-sugar levels by an impressive 10 percent—but required a daily dose of sulforaphane equal to munching 11 pounds of broccoli, according to a university press release. Sulforaphane seems to target the over-production of blood sugar in the liver, a major problem in type 2 diabetes.
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Stopping bacteria that cause type 1 diabetes
French researchers are taking a close look at gut bacteria that can activate MAIT lymphocytes—specialized immune cells that, it turns out, are the warriors that attack insulin-producing islet cells in the pancreas, kickstarting type 1 diabetes. The discovery could lead to new ways to prevent this destruction.
Getting the pancreas to heal itself
Could the pancreas hold the key to curing type 1? University of California, Davis, researchers noticed something new when examining the human pancreas under powerful microscopes: Baby beta cells that could mature into new insulin-making cells, the scientists report. The trick will be kick-starting these beta cells so they can take over insulin production, they say.
The perfect diabetes diet?
Intermittent fasting—two days of extremely low-calorie eating per week, coupled with five days of moderate munching—may help stabilize blood sugar in type 1s and type 2s, according to lab studies from the University of Southern California. In mouse studies, this eating style helped regenerate insulin-producing cells in the pancreas, increasing insulin production.
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