Five research highlights from EASD conference 2023

A drug to prevent overnight hypos

Hypos are a scary part of having type 1 – especially when they occur during the night. So, Breakthrough T1D UK has been supporting clinical trials of a drug called ZT-01 which can help prevent hypos by restoring glucagon activity. Glucagon is a hormone that counteracts insulin, when glucose levels drop too low, glucagon triggers glucose release from the liver into the blood to avoid hypos.

A new clinical trial called ZONE is testing ZT-01 in people with type 1 diabetes. The researchers are recruiting adults aged 18-75 across the US and gave the first dose of ZT-01 in September 2023. The people who take part will receive a daily injection of either the low, medium or high dose of ZT-01 for 28 days and a placebo for 28 days.

The researchers are mainly looking at how many nocturnal hypos the participants have but will also measure their time below range and any other hypos they experience. This exciting drug has the potential to protect against overnight hypos and help adults with type 1 to manage their blood glucose levels.

Clinical trials for type 1 and kidney disease

Complications of diabetes featured in several sessions at this year’s conference, with chronic kidney disease (CKD) a key topic of discussion. Research is underway into early detection and prevention of CKD, but there are many people with type 1 who are already living with CKD. On the third day of the conference, we heard about an upcoming clinical trial of a treatment for CKD in people with type 1.

FINE-ONE is a clinical trial of the drug finerenone, which is already approved on the NHS to lower the risk of kidney failure in people with type 2 diabetes. In FINE-ONE, researchers will test finerenone in 220 people with type 1 and CKD. The clinical trials will take place in several countries including the UK over six months. Find out more about FINE-ONE, including how to take part.

Diabetes distress

We were pleased to see diabetes distress recognised on such a big international stage with a session titled ‘Healing the feelings in type 1 diabetes’. Diabetes distress is defined as the range of emotional responses to managing diabetes, including feeling overwhelmed, defeated, worried and burnt out. But it’s not just the person diagnosed with type 1 who can experience diabetes distress, we heard how family members also experience physical and psychological complications of their loved ones’ diabetes.

Most parents of children with type 1 experience clinically significant depression and anxiety, especially in the first year after diagnosis, with up to 30% reporting clinical distress. Researchers found the main causes of this distress are fear of hypos, anxiety around long-term diabetes complications, and access to daily supplies. This can lead to caregivers being overprotective, prioritising their child’s blood glucose levels over creating an open dialogue with their child about their condition. Family distress is also linked to adolescents paying less attention to managing their diabetes, and children having higher HbA1c levels and less stable blood glucose levels.

This collection of research presents a new target to help treat type 1, with researchers encouraging diabetes healthcare professionals to pay more attention to the families of their patients with type 1. Supporting families of people with type 1 and monitoring general and diabetes-related family function can help improve diabetes care.

Protective coating for insulin-producing cells

A photo of AdoShell®: islets (black dots) suspended in an immunoprotective gel.

Transplants of insulin-producing clusters of cells called islets, either grown in a lab or from a donor, are believed by many people to hold exciting potential as a cure for type 1 diabetes. Currently, people who receive islet transplants must take drugs to suppress their immune system so that it doesn’t destroy the new cells, but these drugs can have bad side effects.

Adoceia, a French biotech company, has developed a protective gel for islets, named AdoShell®, which keeps them safe from the immune system without the need for immunosuppressant drugs. AdoShell® is a semi-permeable soft coating, which lets insulin out but stops harmful immune cells getting in to attack the islets. Their researchers have been testing AdoShell® on human cells in petri dishes and in animals. The latest results from these trials were presented at the 2023 EASD conference.

The human islets encapsulated within AdoShell® responded to glucose by releasing insulin just as well as islets that weren’t in a protective coating, meaning the gel wasn’t interfering with the islets’ function. In some animals, this insulin release was still present seven months after the device was implanted. Because of the safety and effectiveness seen in their preclinical trials, Adocia is planning to run a clinical trial in people with type 1 in 2024.

Find out more about encapsulation on our Cure Research webpage.

Weekly insulin as effective as daily insulin

Imagine if you only had to inject your basal insulin once a week instead of every single day. You may not need to imagine for much longer as Novo Nordisk announced the latest results from its ONWARDS clinical trials. At this year’s EASD, we heard the results, published in The Lancet, of their first large-scale study of 582 adults with type 1 comparing a daily insulin named degludec with a weekly insulin called icodec.

The researchers found no difference in the time in range or HbA1c between the people who took icodec vs those who took degludec. While these findings are promising, showing this weekly insulin is as effective as a daily insulin, icodec did lead to more hypos, although the overall rate of hypos among participants was low. These results provide important information about the safety and effectiveness of weekly insulin and inform the next round of icodec clinical trials.