PREDICTING AND DIAGNOSING TYPE 1 DIABETES IN ADULTS
Researchers are developing better methods of predicting and diagnosing type 1 diabetes — particularly in adults who develop the disease but may initially be misdiagnosed with type 2.
In studies presented at the European Association for the Study of Diabetes (EASD) 2017 Annual Meeting in Lisbon, Portugal, in September, researchers shed light on how genetic profiling can increase our understanding of the differences between people who develop type 1 diabetes as children and those who develop it as adults.
One study followed up on research, presented last year at the EASD Annual Meeting, which found that half of all people with type 1 diabetes develop the disease after the age of 30. The new study found differences in allele patterns between the two groups (children and adults with type 1). Alleles are variant forms of genes.
The study identified which allele patterns were most predictive of people who would ultimately develop type 1 diabetes as adults, compare to those in people who would develop it as children. It also identified one genotype that appeared to be protective against type 1 throughout life.
The second study used genetic risk scores to predict the development of type 1 diabetes among people who tested positive for type 1 antibodies but who had not yet shown signs of illness.
Type 1 diabetes often develops slower in adults than it does in children, so that insulin may not be immediately necessary following diagnosis. Because of this, adults with type 1 diabetes are often misdiagnosed as having type 2. Genetic profiling could greatly reduce this confusion.
DOUBLE DUTY: METHODS FOR REDUCING OBESITY ALSO REDUCES DIABETES
Research shows that weight loss, if you are obese, can be an effective strategy in helping to prevent type 2 diabetes for many people. But sometimes the treatments used to reduce weight can also assist in improving glycemic control, independent of weight loss.
One recent study found that the weight-loss drug lorcaserin — prescribed to control appetite by targeting hormones in the brain — also modifies neuron activity, thereby better regulating blood glucose levels. The study was recently published in the journal Molecular Metabolism.
A second study, published in the New England Journal of Medicine in September, found that gastric bypass surgery, used to reduce weight in those who are severely obese, was effective at reversing and preventing type 2 diabetes over a 12-year period. Previous research has shown that this type of surgery helps to reverse diabetes even before weight loss occurs.
MONITORING BLOOD GLUCOSE WITHOUT PAINFUL FINGER STICKS
The U.S. Food and Drug Administration (FDA) has approved the first continuous blood glucose monitor that can be used without the twice-daily finger-stick tests needed to calibrate other such devices.
Approved in September, the monitoring system allows patients to wave a reader device over a small under-the-skin sensor attached to the upper arm to determine current blood glucose levels, as well as any changes in levels over the past eight hours.
It does have some limitations. For example, it does not contain an alarm system that would automatically alert users when blood glucose levels rise or fall, which can occur during sleep.
The FDA has approved the device for adults with type 1 and type 2 diabetes. The device can be worn for up to ten days.
About 345,000 Americans currently use continuous glucose monitoring devices.
“The FDA is always interested in new technologies that can help make the care of people living with chronic conditions, such as diabetes, easier and more manageable,” says Donald St. Pierre, acting director of the Office of In Vitro Diagnostics and Radiological Health and deputy director of new product evaluation in the FDA’s Center for Devices and Radiological Health.
“This system allows people with diabetes to avoid the additional step of finger-stick calibration, which can sometimes be painful, but still provides necessary information for treating their diabetes — with a wave of the mobile reader.”
EVEN-FASTER-ACTING INSULIN IS APPROVED
There’s fast-acting insulin, and then there’s even-faster-acting insulin. Recently, the FDA approved the fastest-acting insulin yet — one that takes effect within two-and-a-half minutes and is used before or within 20 minutes of the start of a meal.
Doctors often recommend that people with diabetes who take insulin do so at meal times, to prevent the spikes in blood glucose levels that can occur after eating. Fast-acting insulin most closely mimics the body’s natural release of insulin after eating.
When taken at meal times, along with long-acting insulin, fast-acting insulins have been shown to lower A1C levels.