COMMENTARY

A Brighter Future for Those With Type 1 Diabetes

Aaron J. Kowalski, PhD; Mark Harmel, MPH, CDCES

Disclosures

August 02, 2022

This transcript has been edited for clarity.

What an amazing time it is to be living with type 1 diabetes in 2022 and see the evolution of diabetes technology. I say this both personally and professionally. My brother was diagnosed with type 1 in 1977 in the days of urine glucose testing and animal insulin. I was diagnosed in 1984, the advent of blood sugar testing. Here we are today in 2022, both wearing hybrid closed-loop systems.

I'm so proud of the role that JDRF played. I was fortunate to be a scientist on the team in 2005 that launched what we called the JDRF Artificial Pancreas Project. Since then, we've funded over $100 million in research. We focused on continuous glucose monitors — something that, again, my brother and I, and now hundreds of thousands of people around the world, are benefiting from. We funded a pivotal trial that showed the effectiveness of CGM [continuous glucose monitoring] devices and was published in The New England Journal of Medicine. Then we focused on closing the loop.

Back then, people said, "Oh, you can't do this. You can't deliver insulin subcutaneously. You might kill people. The sensors aren't accurate enough." We did the research. We showed that it could be done. Today, in 2022, we have three commercially available systems (Medtronic, Insulet, and Tandem), and we have what we call do-it-yourself systems that people have put together, built their own algorithms, that allow people to control their diabetes off their cell phones.

I wear two hats. I wear the hat of a scientist in the diabetes field and a person with diabetes. The scientists and clinical people often think of glycemia, and we know that these hybrid closed-loop systems work there. They improve glycemia, more time in range, better A1c, less hypoglycemia.

It works across the spectrum. It works for people who have tight control and it works for people who struggle with their diabetes. We've seen A1cs come down from 10's into the 7's, and we see people who have 6.5's maintain those A1cs with less hypoglycemia.

The glycemic benefits are profound, but as a person with diabetes, it's more than just glycemia. We have to appreciate that there's more to life than diabetes. Hybrid closed-loop systems help improve our quality of life, whether it's sleeping through the night, fewer alarms, or less anxiety about lows.

The life around diabetes is not just the person. It's my wife, my kids, and my parents. This ecosystem that evolves around and supports the person with diabetes benefits from these technologies as well. I often use a teeter-totter analogy for glycemia and quality of life: The beauty of these hybrid systems is that they're helping on both fronts.

I often joke that you'll never find somebody who doesn't have diabetes who wears an insulin pump. By that, I mean that people with diabetes wear pumps because they benefit their life, their health, and their quality of life. It's not like somebody out in the world who doesn't have diabetes puts a pump on for kicks.

That's an important distinction because, ultimately, the goal of JDRF is to drive to a future where we don't have to wear pumps, but instead, we get all the benefits of better glycemic control, lifting the burden of diabetes management off our shoulders through cellular- or immunotherapies. We're seeing amazing progress on that front, whether it's stem cell–derived islets, immunoregulatory cells, or different drugs that might reduce the burden of the immune response of type 1 diabetes.

I think the future is incredibly bright for a day where we can take our pumps off and move to endogenous insulin production again in type 1 people.

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