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Year in Review highlights major advances in diabetes research


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The past year has been a blockbuster for diabetes research. New agents and approaches have been developed to address diabetes-related kidney failure, heart failure with preserved ejection fraction (HFpEF), and liver disease. New discoveries have meant the development of new nomenclature focusing on the metabolic dysfunction that underlies diabetes and its complications. And new approaches to diabetes have been borrowed from oncology and other disciplines.

Vanita R. Aroda, MD
Vanita R. Aroda, MD

“There is no system or condition that is not affected by diabetes,” said Vanita R. Aroda, MD, Director of Diabetes Clinical Research at Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School. “Diabetes is the sweet spot of prevention. If you understand diabetes, you will have a unique understanding and perspective of all of medicine.”

Dr. Aroda discussed clinical science discoveries on Monday, June 24, during the ADA Symposium—Major Advances and Discoveries in Diabetes—The Year in Review. This session can be viewed on-demand by registered meeting participants on the virtual meeting platform. If you haven’t registered for the 84th Scientific Sessions, register today to access the valuable meeting content through Aug. 26.

STEP-HFpEF, STEP-HFpEF-DM, FLOW, SELECT, and other trials reinforced the growing recognition that diabetes and its many complications are all interconnected, and the interrelated aspects of metabolic dysfunction can affect every organ and system from brain to feet.

Clinicians have long known that the central nervous system, muscle, adipose tissue, cardiovascular system, kidneys, eyes, liver, and other organs are interconnected, Dr. Aroda said, but it took a novel therapeutic—semaglutide—and the growing number of glucagon-like peptide-1 (GLP-1) receptor agonists, to put it all together in practice.

The recognition of metabolic dysfunction as a driver of disease has also led to nomenclature changes. Nonalcoholic fatty liver disease (NAFLD) has become metabolic dysfunction-associated steatotic liver disease (MASLD). Similarly, nonalcoholic steatohepatitis (NASH) is now metabolic dysfunction-associated steatohepatitis (MASH).

Cardio-kidney-metabolic (CKM) health is a new concept in primary prevention focusing on the root cause of disease. Clinicians can screen for CKM risk factors, assess risk, determine CKM stage, and treat CKM factors using guideline recommendations for statins, sodium-glucose cotransporter protein-2 (SGLT2) inhibitors, GLP-1 receptor agonists, and other agents.

Translational Science

Mary-Elizabeth Patti, MD
Mary-Elizabeth Patti, MD

“We all recognize the need for a multipronged approach to diabetes,” added Mary-Elizabeth Patti, MD, Senior Investigator and Director of the Hypoglycemia Clinic at Joslin Diabetes Center, and Associate Professor of Medicine at Harvard Medical School, who provided an overview of recent developments in the translational science of diabetes. “Glycemic control without hypoglycemia is just one prong.”

One key change in translational science in the past year has been a broad recognition that maintaining and improving quality of life is the key to long-term success in diabetes care. So is dampening the autoimmune process and finding ways to preserve, augment, or restore beta-cell function.

The PROTECT trial of teplizumab and the BANDIT trial of baricitinib are promising steps in protecting beta-cell function as measured by stimulated C-peptide and improved glycemic management, Dr. Patti said. Verapamil, a familiar calcium channel blocker, can also preserve beta-cell function.

Diabetes complications have long been split between microvascular and macrovascular disease. New nomenclature is shifting the focus to the underlying biology, Dr. Patti explained. Vascular tissue disease includes cardiovascular disease (CVD). Vascular-parenchymal mix applies to wound healing, nephropathy, neuropathy, and retinopathy. Parenchymal tissue mix covers cancers and central nervous system dysfunction.

Complications are increasingly being seen as an imbalance between protective factors and risk factors, Dr. Patti noted, adding that this shift in perspective opens new possibilities for intervention on both sides of the balance.

Basic Science

C. Bruce Verchere, PhD
C. Bruce Verchere, PhD

Beta-cell dysfunction is central to both type 1 and type 2 diabetes. Multiple research groups are focusing on ways to maintain, improve, restore, and replace beta-cell functionality, explained C. Bruce Verchere, PhD, Professor of Surgery and Pathology & Laboratory Medicine, and Head of the Diabetes Research Program, University of British Columbia, Vancouver, Canada. Dr. Verchere discussed advancements in the basic science of diabetes.

A growing focus on the basic biology of beta-cells and pancreatic islets is better characterizing the alpha-cells, beta-cells, other endocrine cells, endothelial cells, macrophages, and other immune cells found in islets, he noted.

“Multiple cell types contribute to islet function and dysfunction,” Dr. Verchere said. “The questions are the genetic and environmental causes of beta-cell dysfunction and death, and how can we better target or replace islet cells for diabetes therapy?”

The past year produced four key approaches to answering those questions:

  • Stem cell-derived beta-cells for transplantation in type 1 diabetes.
  • Mechanisms by which beta-cells contributed to autoimmunity and disease pathogenesis.
  • Better understanding of genetic causes of islet dysfunction in type 2 susceptibility.
  • Novel insights from human pancreas and islet consortia.

“We have a long way to go, but we are getting closer (to answers),” Dr. Verchere said.

Get On-Demand Access to the Scientific Sessions

There is still time to register for on-demand access to learn about the latest advances in diabetes research, prevention, and care presented at the 84th Scientific Sessions. Select session recordings will be available through Aug. 26.