• Type 1 diabetes care has rapidly progressed since insulin therapy became standard of care.
• Advances in diabetes technology, immunotherapies and stem cell research are paving the way for more advances.

PHILADELPHIA — Advances in three key areas are leading to a paradigm shift in type 1 diabetes treatment and research, according to a speaker at the Breakthrough T1D Clinical and Research Congress.

Chantal Mathieu, MD, PhD, full professor in the faculty of medicine at KU Leuven in Belgium, said the treatment of type 1 diabetes has gone through a series of changes over the past few decades. The publication of findings from the Diabetes Control and Complications Trial in 1993 paved the way for intensive insulin therapy to become standard of care in type 1 diabetes. Following that, the advent of novel insulin therapies, diabetes technology and better education helped pave the way for more effective treatment of the disease.

Now, type 1 diabetes is progressing in three distinct areas. During her keynote lecture, Mathieu described how new developments in diabetes technology, immunotherapies and islet cell transplantation could further transform how type 1 diabetes is approached and managed in the near future.

“The future type 1 diabetes paradigm is looking very bright,” Mathieu told Healio. “ It will be a combination of better technology with this artificial pancreas ... being the standard of care for most people with type 1 diabetes until we find a cure and until we’re able to fully prevent the disease.”

Mathieu said diabetes technology is quickly progressing because of the release of more advanced algorithms and AI.

“We are now having very smart insulin pumps that will eventually, in the very close future, be able to become what we used to call an artificial pancreas,” Mathieu told Healio. “Sensors continuously measuring glucose levels, then algorithms and AI [are] sensing when a meal is being taken, when exercise is happening, and adapting the rate of insulin delivery of insulin pumps. That pathway is [advancing] very rapidly and is probably, in the near future, an important paradigm shift in the treatment of most people living with type 1 diabetes.”

The availability of teplizumab-mzwv (Tzield, Sanofi) to delay the onset of type 1 diabetes in people with stage 2 or stage 3 disease has been a huge shift, according to Mathieu. Teplizumab’s approval and the development of more immunotherapies in the pipeline allow clinicians to prescribe a treatment for people who test positive for type 1 diabetes autoantibodies. This has made type 1 diabetes screening more crucial than ever, Mathieu said.

“In Europe, we have a project called EDENT1FI, where we are asking questions, like ‘How can we now bring [type 1 diabetes screening] into our healthcare systems?’” Mathieu said. “One country, Italy, has now implemented this in the law that all children should be screened for early-stage type 1 diabetes. [There is] a lot of hope in that pathway, that indeed with disease-modifying therapies, we will be able to interfere with the destruction of the beta cell.”

The final area where progress is being made is with stem cell research. Mathieu said islet transplant programs are evolving “very rapidly” as pluripotent stem cell technology now allows the production of a large number of beta cells.

“If we can combine the transplantation of these newly generated beta cells together with the disease-modifying therapies, we [will] be able to interfere with the autoimmune destruction,” Mathieu said. “Then, there is hope of a cure for those already living with type 1 diabetes.”

Chantal Mathieu, MD, PhD, can be reached at chantal.mathieu@uzleuven.be.