It’s no exaggeration to say that diabetes is a national health emergency. More than 30 million adults and kids have some form of the disease. Type 1, caused by an immune system attack on the pancreas, usually strikes younger people and follows them throughout their lives. Type 2 is more common and is caused by resistance to the hormone insulin, which tells the body to absorb blood sugar. And 84 million people exhibit signs of prediabetes, which means they have a one-in-ten chance of developing full-blown type 2 diabetes if not treated.
Yet over just the past few years, a remarkable number of diabetes treatments, from medications to surgical solutions to high-tech devices, have shown promise. It’s too soon to declare victory, but these breakthroughs have given people with diabetes something sweet: winning strategies for today and considerable hope for the future. Here are eight that show great promise.
For Pre-diabetes: The National Diabetes Prevention Program
What it is: At one time, Philadelphia police officer Eric Scott, 57, wouldn’t think twice about finishing a quart of ice cream after work. He’s also a fan of his city’s signature snack food: “hot soft pretzels with plenty of mustard.” But when a routine health check revealed that his blood sugar was in the prediabetes range, Scott knew he needed to make some changes. So he joined the National Diabetes Prevention Program (DPP) at Temple University, a research-backed yearlong course aimed at helping people with prediabetes eat healthier, exercise more often, and drop enough weight to slash their risk of having their disease progress to type 2 diabetes.
“It works,” says Scott. “I’ve lost 20 pounds, and my blood sugar is lower. I now eat twice as many vegetables, lots of fish and chicken, and way less greasy, oily junk food. I count calories and fat grams and weigh myself every day. And yes, I still have a hot pretzel once in a while, but now I take out the doughy middle to cut carbohydrates and calories. That’s one thing I really like about this program—it helped me find strategies that really fit my life.”
How it works: “Reducing fat is key,” says David Nathan, MD, the study’s lead researcher, a professor of medicine at Harvard Medical School, and the director of the Diabetes Center at Massachusetts General Hospital. “Fat cells, particularly at the abdomen, release hormones that increase risk for diabetes. And it takes only a small amount of weight loss to lower risk. We found that dropping just two pounds lowers your odds for diabetes over three years by about 16 percent.”
Available at hundreds of YMCAs, hospitals, health centers, churches, work sites, and other locations across the country, the DPP is based on a landmark 2002 study that tracked 3,234 overweight people with prediabetes who were divided into three groups: One group undertook simple lifestyle changes, with a goal of at least 150 minutes of exercise per week and a 7 percent weight loss; the second group took metformin, a blood sugar–lowering pill; and the third, the control group, made no changes. After three years, only 14 percent of those in the lifestyle group developed type 2 diabetes, compared with 29 percent in the control group and 22 percent in the metformin group. The lifestyle modifications were so effective, in fact, that the study was stopped a year earlier than planned because the researchers wanted to offer them to all the participants. This spring, Medicare is expected to begin covering the $429 cost of joining a DPP for people ages 65 and older who have prediabetes.
For Pre-diabetes: Metformin
What it is: The nation’s most widely used type 2 drug, metformin is cheap—generics cost $4 or are even free at pharmacies—and safe. Now, 15 years after the study that spotlighted metformin’s potential effectiveness, evidence that it can prevent type 2 diabetes has continued to grow.
How it works: Metformin reduces blood sugar by lowering the amount of sugar coming from the liver. A 2017 Georgetown University review showed that it cuts the risk of developing type 2 diabetes by 18 percent over 15 years.
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For type 2 diabetes: Metabolic Surgery
What it is: Three days after Lisa Shaffer had gastric bypass surgery at the Cleveland Clinic, her uncontrolled diabetes disappeared. “I had diabetes during pregnancy with both of my daughters. After the second, it never resolved. My blood sugar just got worse and worse over the next eight years, despite a healthy diet and daily walks, plus insulin, metformin, the injectable type 2 drug Byetta, and other medications,” says Shaffer, now 45, of Jefferson, Ohio. “But I was off all medication within days of my weight-loss surgery. Eight years later, I still am.”
Rerouting the digestive system with gastric bypass surgery (so called because it creates a smaller stomach and bypasses part of the small intestine) or with a sleeve gastrectomy (which reduces the size of the stomach by about 80 percent) is a drastic diabetes solution. After all, it’s major surgery, with small but real risks for complications such as infections, bleeding, and gastrointestinal problems. It’s also not a stand-alone solution.
How it works: Reducing the size of the stomach makes it easier for patients to stick with smaller portions—but people are also strongly urged to follow a healthy diet. New research is showing that the surgery produces safe, long-lasting benefits, particularly in people with recently diagnosed diabetes, such as Lisa Shaffer. She’s a participant in a landmark Cleveland Clinic study tracking 150 women and men with type 2 diabetes. Two thirds had metabolic surgery; the other third received intensive medical therapy, including weight-loss counseling, regular blood sugar checks, and medications for their diabetes. After five years, 45 percent of those who had gastric bypass and 25 percent who had a sleeve gastrectomy were off all diabetes drugs. In contrast, nobody in the medical-therapy group was medication-free. Surgery recipients also lost more weight, an average of 41 to 51 pounds versus about 12 for the medical-therapy group. (Shaffer lost 127 pounds in ten months!)
“People who have surgery within five years of their diagnosis with type 2 have a 70 to 75 percent chance of a complete remission,” says lead study author Philip R. Schauer, MD, a professor of surgery at the Cleveland Clinic Lerner College of Medicine and director of the Cleveland Clinic Bariatric and Metabolic Institute. “Even those who don’t achieve remission are doing better than before. Long-term blood sugar control is much better, which reduces the risk for horrible complications like blindness, kidney disease, heart attack, and stroke.” In 2016, the American Diabetes Association joined more than 45 medical organizations in endorsing surgery for people with moderate to severe obesity and diabetes. The organization even said it’s an option for those with mild obesity whose diabetes is not well controlled by medications.
Dr. Schauer is quick to add that the first steps in battling diabetes should be lifestyle changes, followed by medications as needed. “If that doesn’t work, consider surgery,” he says. “Don’t wait years to do it. The consequences of poorly controlled diabetes are just too great.”
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For type 2 diabetes: Double-Duty Drugs
What they are: In 2014, Vicki Williams, 62, got serious about her type 2 diabetes. After extremely high blood sugar landed her in the hospital, this Milton, Delaware, woman lost 130 pounds in nine months on a strict doctor-prescribed diet and switched from metformin to a combination pill called Kombiglyze. One of a growing number of “combo drugs” on the market for the treatment of type 2, it contains saxagliptin, which triggers her pancreas to release more insulin, plus metformin, which prompts her liver to release less blood sugar and helps her muscles absorb more blood sugar. “It works a lot better for me, without the weight problems I had when taking metformin alone,” says Williams, whose sugars are now in the healthy range. Other common side effects of metformin include nausea, diarrhea, and vitamin B12 deficiency.
Another double-drug trend showing promise: diabetes drugs that also help your heart. In 2016 and 2017, the FDA approved new labels for the diabetes drugs liraglutide (Victoza) and empagliflozin (Jardiance), touting their ability to reduce heart attacks, strokes, and deaths by up to 13 percent. Since about 70 percent of people with type 2 diabetes die from heart disease, this is a lifesaving benefit.
How they work: Two-in-one treatment is quickly becoming standard for people with type 2. Up to 43 percent of them now take two or more diabetes drugs, according to a recent international study of the medical treatments of 70,657 people with type 2. In the past five years alone, the FDA approved a dozen new combination drugs.
“Taking one pill or getting one shot instead of two is more convenient and may help people stick with their medication. You may need lower doses,” says John Buse, MD, PhD, chief of the Division of Endocrinology at the University of North Carolina at Chapel Hill School of Medicine and director of the UNC Diabetes Care Center. “And for people with type 2 who move to insulin when other diabetes drugs don’t work well enough, a ‘double drug’ that combines insulin with another medication can minimize insulin side effects like weight gain and hypoglycemia (low blood sugar episodes).” It may even help you save a little money.
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For type 1 diabetes: The Artificial Pancreas
What it is: High atop a Virginia mountain, 16 kids and teens with type 1 diabetes put the next big thing in blood sugar control to the ultimate test. “We wore either an experimental artificial pancreas or a continuous glucose monitor and insulin pump while we snowboarded and skied six hours a day for five days,” says Thomas Hallett, 17, a high school junior from Williamsburg, Virginia.
You can’t yet buy an artificial pancreas system that both senses blood sugar and delivers insulin automatically, but that could change soon. The University of Virginia’s experimental InControl system, now licensed to a Charlottesville tech company, could gain FDA approval in about a year, says endocrinologist and codeveloper Daniel Cherñavvsky, MD, of the Center for Diabetes Technology at the University of Virginia School of Medicine in Charlottesville. The ski-camp study, published in August 2017 in the journal Diabetes Care, showed that “the system kept blood sugar within a healthy target range despite the cold and altitude, which can affect equipment, and the excitement, fear, and intense exercise, which can affect blood sugar significantly,” he says. InControl is one of four promising artificial pancreas systems that received major funding from the National Institutes of Health in 2017, a sign of how important these devices could be for people with diabetes and their families.
How it works: Just like a healthy human pancreas, an artificial pancreas system automatically senses blood sugar levels. It uses a device called a continuous glucose monitor alongside an insulin pump that processes the data to deliver just-right spurts of insulin round the clock. That reduces the need for finger sticks, blood sugar checks, insulin shots, and having to program an insulin pump by hand. “It’s life-changing,” Dr. Cherñavvsky says. “An artificial pancreas nearly eliminates dangerous low blood sugar episodes that can lead to a coma and hospitalization or even death for insulin users. That’s a huge worry, particularly for parents of children with type 1. And it reduces high blood sugar spikes that over time lead to diabetes complications.”
Thomas Hallett’s mom agrees. “I don’t think we slept through the night until Thomas was five years old,” says Mara Hallett. “We got up several times to check his blood sugar. Keeping blood sugar under control with insulin is crucial, but it increases the risk for hypoglycemia.” Through the years, the Halletts have embraced new technologies that cut that risk. These include glucose monitors that sound an alarm when blood sugar dips and a partially automatic system from Medtronic that adjusts insulin doses when it senses changes in blood sugar. “A fully automatic artificial pancreas will reduce worry,” Mara says. “And I’ve noticed another benefit. High-tech diabetes devices help teens with diabetes see the big picture—they see how their blood sugar numbers trend throughout the day, almost like a video game. They see how their actions—how they eat and exercise and sleep—make a difference. They’re more invested in good control.”
For type 1 diabetes: Islet Cell Transplants
What they are: Islet cells in the pancreas make insulin; when they die out, type 1 diabetes results. So wouldn’t transplanting healthy new islet cells fix the problem? Islet cell transplants are commercially available in many countries (including Canada, the United Kingdom, and Australia), but the procedure is still experimental in the United States because of concerns about its effectiveness and the short supply of human islet cells available for transplanting.
How they work: In a recent study, when 48 people whose type 1 diabetes was extremely difficult to control (leading to life-threatening low blood sugar episodes) received islet cell transplants, 52 percent had healthy blood sugar levels one year later without insulin. And in a 2017 University of Miami case study, a 43-year-old woman from Texas with unstable type 1 diabetes made headlines when she passed the one-year mark insulin-free after a procedure that transplanted islet cells into her abdomen. That process could bypass the inflammation and islet cell loss that lower the success rate in typical islet cell transplants, which require infusing the cells into the bloodstream through the portal vein, which carries them to their new home in the nearby liver. (Islet cells aren’t transplanted back into the pancreas, because the risk for complications is high.) “Transplants are getting better and better, but there’s more work to do,” notes Dr. Nathan. “Right now, the cells tend to last three to five years. And recipients must take immune-suppressing medications for life so their body won’t reject them.”