Stem cells, pumps and monitors help type 1 patients manage their diabetes

Nov. 14 marked the birthday of Frederick Banting, who co-discovered insulin in 1922, with Charles Best.

In type 1 diabetes, the pancreas produces little or no insulin — a hormone needed to allow sugar (glucose) to enter cells to produce energy. The chronic disease once known as insulin-dependent diabetes and/or juvenile diabetes is usually diagnosed in children and in young adults.

Type 1 diabetes occurs when the body’s immune system attacks and destroys the insulin-producing beta cells of the pancreas. When the beta cells are destroyed, the body can no longer make insulin.

There is no cure for type 1 but over the last 100 years, researchers, scientists and endocrinologists have developed treatments in which glucose can be delivered more quickly to the cells.

About 5 percent of the 34 million Americans who have diabetes have type 1, according to the Centers of Disease Control and Prevention. One in every 300 children have type 1, requiring them to take insulin throughout the day.

Fashion-forward teen aids diabetes research

Lauren Buchwald, 14, of Parkland was diagnosed with type 1 diabetes when she was 2 years old.

“Some of the struggles I have gone through while living with type 1 diabetes was always having to carry around a test kit when I am with my friends or having to always wear an insulin pump on my body,” she said.

In March, during COVID-19 quarantine, she started a casual clothing company called Splattered Essentials, which is now carried in five stores around the country, including South Florida, New York and Illinois. Items can also be purchased at SplatteredEssentials.com.

“Even when I was little, I always wanted a clothing business, and it finally happened,” she said.

A portion of her company’s sales go to the Diabetes Research Institute Foundation, part of the University of Miami Health System.

“Their support has made living with type 1 diabetes easier and their research gives me hope.

“Managing type 1 diabetes gets easier and easier as time passes, especially with all of the technology these days,” Buchwald said. “I never let type 1 diabetes get in my way.”

Clinical trials testing how to prevent type 1

Dr. Camillo Ricordi and his team at the Diabetes Research Institute and Cell Transplant Center at the University of Miami Miller School of Medicine have been pioneers in stem-cell treatment for type 1 diabetes.

Their research has resulted in improved insulin production from the pancreas, thus helping to prevent complications such as neuropathy, nephropathy and retinopathy (conditions affecting the nerves, often in the hands and feet, and the eyes).

“We are planning to offer stem-cell treatments for several diabetes cure-focused clinical trials, from stopping type 1 at the onset to preventing the long-term complications of the disease,” said Ricordi, the institute’s director.

The trials also are trying to reverse kidney disease, another complication from diabetes, and improve transplanting “stem-cell derived insulin-producing cells,” he noted.

Clinical trials should begin in early 2021.

Looking into diet and lifestyle changes

The institute recently launched an international collaboration to study how lifestyle and diet can help prevent severe complications of viral infections such as COVID-19, and autoimmune diseases such as type 1 diabetes, which are triggered by hyper-inflammatory responses.

“We have been working at the forefront of the battle against type 1 diabetes, the tip of the iceberg of the autoimmune disease epidemics now affecting approximately 20% of the population with over 100 disease conditions,” said Ricordi.

He and his team believe that pro-inflammatory diets can predispose people to type 1 diabetes. Similarly, he says those factors can increase the risk of life-threatening complications of viral infections, such as those from severe cases of COVID-19.

About 25 percent of people hospitalized with severe COVID-19 infections are diabetics, studies show.

He said that randomized controlled trials, Poseidon trials, are in progress to determine the effect of high doses of Omega 3 and Vitamin D on disease progression in both children and adults, in early and late onset type 1 diabetes.

“Low Vitamin D levels have been associated with the severity of type 1 diabetes at onset ... and with severity of COVID-19 progression,” he said. “Omega 3 has been shown to reverse autoimmune diabetes in pre-clinical research and lower levels of Omega 3 have been associated with an increase in all-cause mortality,” Ricordi said.

He and his team are also launching the fit4pandemic initiative (fit for pandemic), with the goal of strengthening immune defenses.

Artificial pancreas helps measure glucose, administer insulin

Dr. Vineeth Mohan, chairman of the department of endocrinology at Cleveland Clinic Florida, says an “artificial” pancreas, which helps keep blood sugar levels under control, can make a big difference in the quality of life for people living with type 1 diabetes.

“The semi-closed loop systems that include insulin pumps integrated with continuous glucose monitors (CGM) allow patients with type 1 diabetes to achieve better control of their condition and reduce their risk of short and long-term complications,” he said.

Furthermore, he said, people can live more freely, without worrying continuously about their blood sugar levels.

Patients wear insulin pumps to deliver insulin under their skin, particularly at meal times, said Mohan. The pumps work with continuous glucose monitors that can monitor a person’s blood sugar levels every few minutes. Insulin pumps have been in use for several decades and the monitors have been used since the early 2000s, he said.

More recently, the technology of insulin pumps and the monitors has advanced so that the pump can read blood glucose readings from the monitor and administer insulin in response to changes in blood glucose.

“These integrated systems work like an “artificial pancreas” in that insulin delivery is coordinated with blood glucose measurement, which helps to keep blood glucose levels more stable,” Mohan said. “We have not yet reached a goal of a true ‘artificial pancreas,’ but have made major advances towards this over the past few years.”

But patients must signal to the pump that they are eating and what they are eating so that the pump provides enough insulin in anticipation of the meal, Mohan said. Patients can also signal to the pump that they are exercising or sleeping.

“Continuous glucose monitors provide a wealth of data to patients and their physicians since blood glucose is measured every few minutes and the data is stored,” Mohan said. “This data can be uploaded by patients and reviewed by their physicians remotely.”

Trying to find triggers that cause type 1 diabetes in children

Dr. Adriana A Carrillo-Iregui, a pediatric endocrinologist with Nicklaus Children’s Hospital in Miami, is studying why type 1 diabetes develops in some children, and not others.

“Diabetes is a chronic condition in which to have it, you have to have a genetic predisposition — specific genes that place you at risk,” she said.

The TEDDY study (The Environmental Determinants of Diabetes in the Young) is based on research that children who have diabetes have certain kinds of genes, but that not all children who are at higher risk get diabetes.

Researchers believe that something happens that “triggers” a child with higher risk genes to get diabetes. The study is trying to identify those triggers.

Data show that type 1 diabetes in children is on the rise and will continue to rise. Early data show that genetic predisposition and environmental factors play a role.

“In terms of environmental factors, although it’s not yet clear, the TEDDY study sheds some light on how probiotics, Vitamin C and Vitamin D can play a role in protection. Still, there’s much to find out in how these factors affect the immune system to create a response,” said Carrillo-Iregui.

A consortium of six Clinical Centers and a Data Coordinating Center across the nation are developing and carrying out studies to identify environmental causes of type 1 diabetes in those who are genetically susceptible.

This story was originally published November 25, 2020 at 6:00 AM.