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BMJ Open Diabetes Research & Care

is an open access diabetes journal from the ADA and BMJ that strives to publish innovative studies on diabetes in all disciplines and therapeutic areas as quickly and transparently as possible.

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BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality basic and clinical research articles regarding type 1 and type 2 diabetes and associated complications. Submissions are subject to rigorous external peer review to ensure the publication of high-quality information. The online-only format allows for continuous updates and serves as an invaluable resource to the multidisciplinary community of endocrinology, public health/prevention and internal medicine.

BMJ Open Diabetes Research & Care is published by BMJ in partnership with the American Diabetes Association .

EDITOR-IN-CHIEF Mandeep Bajaj, MD, FRCP, Baylor College of Medicine Editorial Board

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Exploring the Interplay between Diabetes and Lp(a): Implications for Cardiovascular Risk

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Current Advances in the Management of Diabetes Mellitus

Chinyere aloke.

1 Protein Structure-Function and Research Unit, School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa

2 Department of Medical Biochemistry, Alex Ekwueme Federal University Ndufu-Alike, Abakaliki PMB 1010, Nigeria

Chinedu Ogbonnia Egwu

Patrick maduabuchi aja.

3 Department of Biochemistry, Faculty of Biological Sciences, Ebonyi State University, Abakaliki PMB 53, Nigeria

Nwogo Ajuka Obasi

Jennifer chukwu.

4 John Hopkins Program on International Education in Gynaecology and Obstetrics, Abuja 900281, Nigeria

Blessing Oluebube Akumadu

Patience nkemjika ogbu, ikechukwu achilonu, associated data.

Not applicable.

Diabetes mellitus (DM) underscores a rising epidemic orchestrating critical socio-economic burden on countries globally. Different treatment options for the management of DM are evolving rapidly because the usual methods of treatment have not completely tackled the primary causes of the disease and are laden with critical adverse effects. Thus, this narrative review explores different treatment regimens in DM management and the associated challenges. A literature search for published articles on recent advances in DM management was completed with search engines including Web of Science, Pubmed/Medline, Scopus, using keywords such as DM, management of DM, and gene therapy. Our findings indicate that substantial progress has been made in DM management with promising results using different treatment regimens, including nanotechnology, gene therapy, stem cell, medical nutrition therapy, and lifestyle modification. However, a lot of challenges have been encountered using these techniques, including their optimization to ensure optimal glycemic, lipid, and blood pressure modulation to minimize complications, improvement of patients’ compliance to lifestyle and pharmacologic interventions, safety, ethical issues, as well as an effective delivery system among others. In conclusion, lifestyle management alongside pharmacological approaches and the optimization of these techniques is critical for an effective and safe clinical treatment plan.

1. Introduction

Diabetes mellitus (DM) is a long-standing, complicated, and non-transmissible endocrine ailment that is growing rapidly and has posed clinical challenges globally, often linked with threats related to complicated metabolic development in patients. It is marked by elevated glucose and lipids in the blood as well as oxidative stress, which culminate in chronic complications involving diverse organs, mainly the kidneys, eyes, nerves, and blood vessels, among others, in the body. As reported by World Health Organization (WHO), DM is an outbreak prone to high malaise and death. Globally, approximately 387 million persons are affected by this disorder and it is estimated to be more than 640 million by 2040 [ 1 ].

According to a report in 2017 by International Diabetes Federation (IDF), 425 million persons suffer from diabetes mellitus out of which more than 90 percent are adults and 352 million had impaired glucose tolerance (IGT) [ 2 ]. In individuals suffering from type II diabetes mellitus (T2DM), hyperglycemia is not the only characteristic; it also involves multiple complications such as kidney failure, blindness, heart attack, stroke, and amputations of the lower limb [ 3 ]. Mounting evidence obtained from epidemiological studies has shown that T2DM is an ailment with numerous causes associated with both polygenic and various environmental factors [ 4 ]. T2DM is thus too complicated to cure due to genetic polymorphism and other numerous risk factors.

Despite the fact that most cases are a result of obesity-linked T2DM, the annual prevalence of T1DM is on the rise [ 5 ]. It has been reported that about 10 percent of people suffering from diabetes have T1DM. However, the two forms are linked with a prolonged risk of circulatory system complexities [ 6 ] and the threat of lowered blood glucose. Ample proof suggests that normoglycemia accomplishment will mitigate the risk of complications linked with DM [ 7 ]. However, hypoglycemia occurrences limit the attainment of near normoglycemia in subjects with T1DM. Diabetic individuals who are not aware of their hypoglycemic status are vulnerable to T1DM which then limits them from the attainment of the needed glycemic control. Globally, DM health centers have several individuals with T1DM who have recurrent low blood glucose and the idea of hypoglycemic unconsciousness poses critical clinical challenges. Providentially, many favorable and interesting gain ground exist in the perspective for subjects with the problem of DM, including gene therapy, as reported by Bosch and colleagues [ 8 ].

Currently, the main therapeutic regimens for T2DM are injection of insulin-like agents and oral administration of hypoglycaemic agents. However, these agents play crucial functions in T2DM treatment but are laden with side effects [ 9 , 10 ]. Insulin has taken the centerpiece for the management of unrestrained insulin-deficient DM since its invention [ 11 ]. Admittedly, due to the severe lack of beta cells, the injection of exogenous insulin is vital for survival. Notwithstanding the advances made in comprehending the etiology, effects, and continuance of DM, including the progress made in insulin development and its analogues, ensuring tight glycaemic modulation without negative side effects such as low blood glucose and gain in weight still poses significant problems [ 7 , 12 , 13 ]. Hence, this further accentuates the importance of alternative techniques or adjuncts to insulin [ 14 ].

Consequently, this narrative review exploits different alternative therapeutic regimen for the management of two forms of DM, including nanotechnology, stem cell technology, gene therapy, medical nutrition therapy, lifestyle modification and the challenges associated with these techniques.

To identify published works on recent advances in the management of DM, the literature search for this narrative review was carried out using different search engines including Scopus, Google Scholar, Pubmed/Medline and Web of Science databases. Keywords and subject headings employed include diabetes mellitus, hyperglyceamia, management of DM, T2DM, nanotechnology in diabetes, gene therapy in DM management and current treatment, etc. The titles and abstracts of the results after the search were painstakingly screened to select eligible articles for full-text reading. Articles that were found to be eligible were retrieved and full-text screening was performed independently by three of the authors to select studies for inclusion in the final analysis. Original research and review articles published between 1993 and 2022 (in English) were included. Unpublished articles and thesis were excluded. All authors confirmed the validity of the selected papers.

3. Risk Factors of Diabetes

There are several risk factors associated with diabetes. These risk factors contribute significantly to the progression of diabetes. They include but not limited to age; weight; family history of diabetes; smoking and race/ethnicity [ 15 , 16 ] (Asiimwe et al., 2020; Noh et al., 2018). While T1DM is mostly found in the young, T2DM is an adult-related condition. The risk of T2DM increases with age which is due to the deficiency of insulin secretion which develops with age, and growing insulin resistance caused by a change in body composition [ 17 ]. Increase in body weight which leads to obesity is closely associated with diabetes in a condition termed diabesity. This is because increase in body weight leads to increased insulin resistance [ 18 ].

According to the FDA, smokers are 30 to 40% more likely to come down with T2DM than nonsmokers. Smoking can also increase insulin resistance which makes the patients require more insulin for the control of their sugar level [ 19 ]. Diabetes is hereditary. Those with the family history are advised to adhere to lifestyles that reduce the risk of developing diabetes.

4. Management of Diabetes

There are several modern approaches involved in the management of diabetes. However, early diagnosis is central to achieving any targets set in DM management [ 20 ]. Each patient is treated with the aim of achieving a particular outcome. These outcomes are set out from the first day of clinic visit to ensure an individualized approach in the management of diabetes.

4.1. Internet Intervention for Lifestyle Modification in Diabetes

Lifestyle modification is an integral part of diabetes management. It is recommended for both patients in pre-diabetic and diabetic conditions, respectively. Reduced sedentary lifestyle, increased physical activities, and healthy diets are among the recommended lifestyle modifications. The right exercise may depend on the state of the patient. The exercise helps to bring down the plasma glucose level. For a healthy diet, it is recommended that diabetic subjects take a lot of vegetables, fruits, and whole grains; choose nonfat dairy and lean meats; and limit foods that are high in sugar and fat. Other lifestyle changes include stopping smoking and reduction in alcohol intake [ 21 , 22 ]. The lifestyle changes are usually individualized.

Even though the above strategies help in the effective management of diabetes, communicating or constantly reminding the subjects to complete them could be challenging. Web or internet-based program have been deployed to improve adherence to the lifestyle changes. These web-based strategies provide a viable option for facilitating diabetes self-management [ 23 ].

4.2. Nanotechnology and Diabetes

Nanotechnology involves the use of nanoparticles (<100 nm). These nanoparticles are developed through the manipulation of individual atoms or molecules in a substance. The application of nanotechnology in medicine is termed nanomedicine. Nanomedicine involves the combination of the knowledge of nanotechnology in the application of drugs or diagnostic molecules which generally improves their ability to target specific cells or tissues. Nanotechnology in diabetes research has played several roles in improving the outcome of diabetic management in diabetics through the deployment of novel nanotechnology-based glucose measurement and insulin delivery techniques [ 24 , 25 ]. Nanotechnology employs non-invasive approaches for insulin delivery and the development of a more efficacious vaccine including cell-based and gene-based therapies for T1DM [ 24 ]. The importance of nanotechnology in diabetes includes, but is not limited to, inventive diabetes diagnosis, detection of immune cell activity and beta-cell mass, monitoring of glucose level, and non-invasive insulin delivery, etc.

Early and accurate diagnosis of a disease may be as important as the treatment of the disease itself. Prompt diagnosis may prevent dysglycaemia and reduce the time to onset of diabetes [ 26 ]. Conventional approaches have been utilized in the different diagnostic needs in diabetes, such as detection of immune destruction that precedes T1DM and/or measurement of plasma glucose levels. However, the shortcomings of the conventional approaches which include, but are not limited to, non-early detection of the disease progression necessitate the need for a novel technology that can improve the diagnostic outcome.

The mass of the beta cell is an indication of the functionality of the beta-cell in secreting insulin. The progressive loss of the beta cells precipitates T1DM [ 27 ]. Prompt detection of the stage of beta cell loss through nanotechnology can allow for the immediate application of clinical interventions for its arrest. Magnetic nanoparticles (MNPs), for instance, have distinctive physical properties qualifying them as outstanding contrast media for magnetic resonance imaging (MRI). This can enable the early detection of the stages of beta-cell loss.

Glycaemic fluctuation should be avoided during diabetic management. Individuals have treatment goals set by their physicians. Regular or daily glucose monitoring is performed to ascertain the control achieved by the treatment and the diabetes progression [ 28 ]. However, this comes with some challenges including poor compliance as a result of the regular pricking of the patients and inability to monitor glucose levels at certain times of the day (e.g., sleeping and driving times). The overall impact is irregular monitoring of the glucose level which can lead to dangerous fluctuations that may worsen diabetic complications. To circumvent this challenge, continuous glucose monitoring (CGM) systems are essential. The implantation of biosensors (e.g., amperometric sensors) subcutaneously had been used to achieve CGM for 10 days; however, this has its drawbacks including instabilities and the need for a weekly change of the implantation [ 29 , 30 ].

Nanomedicine can overcome the aforementioned obstacles in CGM. The glucose-sensing device has three key components: a detector, a transducer, and a reporter. The detector measures the glucose level while the transducer converts the measurement into an output signal. The reporter finally processes the signal into an interpretable form. For an effective measure of the glucose level, the glucose sensors are usually made of nanoparticles in nanotechnology which are made from mainly three molecules: glucose oxidase, glucose-binding proteins, and glucose-binding small molecules [ 24 , 31 ]. The coupling of these nanoparticles as transducers enables the accurate detection of glucose in a patient-friendly and rapid manner [ 31 ].

Insulin shots are the mainstay in the management of T1DM and T2DM. The conventional approach of insulin delivery involves the use of needle injections. Even though some needles have been significantly improved to be painless during delivery, the thought of needles alone could be discouraging [ 32 ]. This significantly affects the compliance of patients to insulin use. Moreover, the lingering time between the time of glucose measurement and the insulin dosing in addition to the hindrance in the absorption of insulin ensuing the conventional subcutaneous injection, do not allow for a close plasma glucose control which leads to fluctuations and times of hyperglycemia [ 24 ]. An approach that is non-invasive will be well accepted by both patients and medical practitioners to improve compliance and the overall outcome of treatment.

To overcome the recent delivery challenges faced by the conventional approaches, microcomputer closed-loop or nano pumps are being developed to ensure the timely delivery of insulin while ensuring continuous glucose monitoring. In other words, this system is built to link insulin delivery to plasma glucose concentration. This will prevent the risk of plasma glucose fluctuations [ 26 , 33 ]. Other less invasive means of insulin delivery that involve the use of nanoparticles are also being explored to facilitate insulin delivery orally, transdermally, and/or via inhalation [ 26 ].

4.3. Medical Nutrition Therapy in Diabetes

Medical nutrition therapy (MNT) is a “nutrition-based treatment provided by a registered dietitian nutritionist.” It comprises nutrition diagnosis and therapeutic and professional counseling services that aid in the management of DM. MNT is a critical aspect of diabetes education and management. Recommendations on MNT by international collaborative groups for diabetes management have attempted to reform and provide courses for adverse nutritional transition [ 34 , 35 ]. For instance, MNT has been employed for the treatment of GDM because carbohydrate (CHO) is the main causative agent as a result of its impact on glycaemia. According to the Institute of Medicine, pregnant women require a minimum of 175 g CHO per day, and low-CHO diets already in use traditionally for the treatment of GDM have proven to be safe [ 36 ]. Moreover, MNT has been reported to be critical in the management of other types of DM and as such has significantly impacted patients, especially women and newborns [ 37 ]. Primarily, MNT ensures the maintenance of euglycemia via adequacy in weight gain in pregnancy and growth of fetus while avoiding ketogenesis and metabolic acidosis. Nonetheless, MNT is yet to establish the optimal diet in terms of energy content and macronutrient distribution, quality, and amount, among others, in DM [ 37 ]. Reports have shown that the nutritional requirements for GDM patients are the same for all pregnancy cases when their carbohydrate intake is taken into special cognizance. Currently, a low-glycemic index diet has been reported to be more favorable in the management of GDM than the traditional intervention of carbohydrates restriction even though the evidence is still restrained [ 37 ]. Caloric restrictions are very vital in the management of overweight or obesity.

Reports have charged MNT with the design of signature diet strategies that will be suitable medically as well as patient focused. By this, it is hoped that practicing diabetologists and registered dieticians (RDs) will partner to furnish nutritional guidelines based on evidence for use by MNT for the prevention and management of DM and related comorbidities [ 38 ]. Indications show that MNT may be a potent, easily available, and cheap therapeutic technique and could be an essential tool for DM prevention and management [ 35 ].

4.4. Gene Therapy and Diabetes Mellitus

Gene therapy is a technique that involves remedying the symptoms of an ailment orchestrated by a defective gene via the incorporation of the exogenous normal gene. Its advantage is that a single treatment can be used to cure any type of disease and currently, gene therapy is opening up novel treatment options in different branches of medicine [ 39 ]. At present, gene manipulation is not limited to the addition of a gene but also gene modulation and editing [ 40 , 41 ]. Gene therapy can also be explained as a method of introduction of a gene or gene manipulation within a cell as a curative regimen in the treatment of disease [ 42 ]. The objective of this approach is to remedy abnormal genes that have been implicated as the causative agent in any ailment and to successfully halt the beginning of the ailment or prevent its continuation. The gene therapy approach involves three major intervention methods: (i) delivery of a new gene into the body, (ii) substitution of the abnormal gene with a working gene, and (iii) disabling the malfunction genes responsible for the ailment [ 42 , 43 ]. Gene therapy can be further classified into somatic gene therapy or germline gene therapy. While the primary target in somatic gene therapy is the somatic cells often referred to as the diseased cells, the reproductive cells are the targets in germline gene therapy. Germline therapy halts the development of the disease in subsequent generations [ 43 ]. The application of gene therapies as trends in evolving therapeutics is due to its potential for the treatment of diverse ailments including DM, autoimmune disorders, heart diseases, and cancers among others that are difficult to manage using conventional therapies [ 44 ].

T1DM is an autoimmune ailment marked by T-cell-orchestrated self-damage of the islet beta cells responsible for the secretion of insulin. Its management is problematic and complex, particularly using conventional drugs. Thus, gene therapy is partly an emerging promising therapeutic alternative in its treatment [ 45 , 46 ]. The etiology of T1DM is multifactorial involving both environmental and genetic factors akin to any other autoimmune disease. In the recent past, researchers have favourably pointed out many genes accountable for the evolution of T1DM [ 47 ]. Thus, alteration or grappling with these genes employing gene therapy techniques will probably foster better comprehensible management of the ailment or even cure T1DM.

Even though gene therapy for DM majorly centres on T1DM, many genes have been evaluated as a probable treatment for T2DM as the ailment has a compelling genetic susceptibility [ 48 ]. About 75 independent genetic loci have been identified for T2DM via genetic linked studies and different novel therapeutic targets have also been determined [ 46 ]. Genetic loci might have a huge impact on drug response in contrast to the incidence and development of diseases whose effects are limited [ 49 ]. Many genetic loci exist with prospects for T2DM gene therapy. For instance, nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) is a good example. NLRP3 inhibition mitigates inflammation, guard against apoptosis of pancreatic b-cells including the prevention of development of T2DM in mice [ 50 ]. Hypothetically, all genes associated with the beginning, evolution, and deterioration of T2DM are probable targets. In Table 1 [ 51 ], the genes that modulate the homeostasis of glucose, ameliorate insulin synthesis or/and responsiveness, and improve diabetic mellitus-induced complications are abridged for simplicity.

Promising targets that can be employed for T2DM gene therapy.

Legend: HSP70 = heat shock protein 70; NLRP3 = nucleotide-binding oligomerization domain-like receptor protein 3; SGLTs = sodium-glucose co-transporters; GLUTs, glucose transporters; SIRT6=Sirtuin 6; FGFs = fibroblast growth factors; GPGRs = G protein–coupled receptors; GLP-1= glycogen-like peptide 1; ADPN = adiponectin; CTB APSL = cholera toxin B subunit and active peptide from shark liver; TGF-a = transforming growth factor-alpha; DKD = diabetic kidney disease [ 51 ].

4.5. Stem Cell Therapy in Diabetes

The conventional approaches in the management of DM do not resolve the causes of the ailment and are laden with adverse effects. Hence, there is a quest for a desirable different therapeutic regimen. The cellular-based therapeutic technique currently in use in DM management is based on the pancreas or islet-cell transplantation to revive the beta cells for insulin secretion. This approach is restricted due to a lack of donor organs. These problems lead to the exploration of the possibility of constructing beta cells using stem cells. The peculiar rebuilding potential of stem cells might be an important tool that could be used in the management of DM. Development of replenishable islets source using stem cells might avert the recent supply/demand problems in the transplantation of islet and furnish DM subjects with a prolonged source of beta cells for insulin secretion. Hence, in the management of DM, stem cell investigation has become a promising approach [ 52 ].

The stem cell DM therapy is aimed at the replacement of malfunctioning or damaged pancreatic cells by employing pluripotent or multipotent stem cells. This technique has exploited the ability of various kinds of stem cells including induced pluripotent stem cells (iPSCs), embryonic stem cells (ESCs), and adult stem cells using diverse methods to produce surrogate beta cells or to bring back the physiologic role of the beta cell [ 53 ].

Advancement in technology has facilitated the development of stem cells using different kinds of tissue sources such as adipose tissue, skin, bone marrow, umbilical cord blood, periosteum, and dental pulp. In searching for promising stem cells, the first organ of choice is usually the pancreas. Studies with animal models have indicated that a small number of pancreatic tissue when made available could bring back the optimum pancreatic beta-cell mass [ 54 ]. This is sequel to the differentiated beta cells from the pancreatic duct undergoing replication and dedifferentiation culminating in the formation of pluripotent cells which in turn synthesize more beta cells. Additional study suggested that these ductal cells populations could be produced in vitro and directed to produce insulin synthesizing clusters [ 55 , 56 ].

Moreover, the haemopoietic adult stem cells such as HSCs and mesenchymal stem cells (MSCs) have the potential to transdifferentiate into so many cell lineages such as the brain, liver, and lung as well as gastrointestinal tract cells [ 57 , 58 , 59 ]. A different group of researchers experimented on the multipotent differentiation of haemapoietic progenitors to replenish the beta cell number in T1DM. It was reported that the bone marrow of mouse was differentiated ex vivo into functional beta cells [ 60 ]. Relatedly, studies using the mice model indicated that cells of the bone marrow could be amenable to the pancreas as a target and that elevated blood glucose could be normalized [ 61 ]. An experiment with autologous HSCs demonstrated an improvement in T1DM and T2DM [ 62 , 63 ]. These studies furnish potential outcomes for the usage of autologous HSCs in the management of DM.

4.6. Latest Inventions in Diabetes Management

In addition to the aforementioned innovations in the management of diabetes, several drugs are still at different stages of clinical trial for eventual use. Others are ready and have been recently introduced into the market.

4.6.1. Drugs Recently Introduced

Tirzepatide: The drug was recently approved by the FDA under the trade name mounjaro for the treatment of T2DM [ 64 ]. Tirzepatide is an injectable given under the skin once in a week which targets the receptors of hormones which play central role in the metabolism of glucose. These hormones are glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). While the GLP-1 reduces blood glucose by several mechanisms, including stimulating insulin secretion and suppressing glucagon release during hyperglycemia, GIP stimulates insulin release during hyperglycemia, but it also stimulates glucagon release during hypoglycemia.

Tirzepatide acts as agonist to their receptors [ 65 ], hence elongating their functions which results in blood glucose control. The efficacy of tirzepatide was established against a placebo, a GLP-1 receptor agonist (semaglutide) and two long-acting insulin analogs either as monotherapy or in combination with other antidiabetic agents [ 64 ]. In comparison to the placebo, it lowered the HbA1c by 11.6% and 1.5% as monotherapy and combination therapy, respectively. In comparison to other antidiabetic drugs, at the highest dose of 15 mg, it lowered the HbA1c 0.5% more than semaglutide, 0.9% more than insulin degludec and 1.0% more than insulin glargine [ 64 ]. Because of the efficacy therein and the once in a week dosing, tirzepatide provides a desirable paradigm shift in the management of T2DM.

4.6.2. Drugs in the Pipeline

Several drug candidates are at different phases of development for the management of DM. These are listed below.

LY3502970: LY3502970 is a partial agonist, biased toward G-protein activation over β-arrestin recruitment at the (GLP-1 receptor (GLP-1R). The molecule is highly potent and selective against other class B G-protein-coupled receptors (GPCRs) with a pharmacokinetic profile favorable for oral administration [ 66 ]. It is a product that is currently being developed by Eli lilly.

SCO-094: SCO-094 is a drug candidate identified by SCOHIA company which has a dual target of the receptors of GIP and GLP-1 [ 67 ]

Ladarixin (LDX): Ladarixin is an inhibitor of the interleukin-8 receptors CXCR1 and CXCR2, in new-onset T1DM [ 68 ]. It is a drug candidate developed by Dompe Farmaceutici. Short term LDX treatment of newly diagnosed patients with T1DM had no appreciable effect on preserving residual beta cell function [ 68 ].

5. Discussion of Major Findings

DM is a complex, progressive, and multifactorial metabolic disorder needing more complex treatments over time. Globally, researchers have worked assiduously in the discovery and development of novel drugs for the treatment of diabetes. There is significant progress in research into the cause and management of T1DM [ 69 ]. Mounting evidence indicates that modern insulin therapy in combination with glucose self-monitoring including blood pressure and lipid monitoring has profoundly improved the long-term prognosis of T1DM [ 70 ]. The literature indicates that regular exercise and improved diet may enhance the quality of life for diabetic subjects but in the absence of adequate exercise and diet, medications may help diabetic persons regulate their blood glucose level. Moreover, implantation of insulin producing cells could furnish the basal glucose level essential for maintaining glucose homeostasis in vivo and thus hinder long-term injury from occurring in different tissues regardless of hormone administration [ 71 ].

The attainment of the full potential of gene therapy technique could be obtained via the design of gene delivery vectors that are safe, efficient, and specific and/ or the development of a technique for engineering of cell, in which the stem cell seems to be of great importance. Thus, the establishment of a reliable, sensitive, and acutely monitored feedback system is needed for the generation of a safe and efficient vector to facilitate diabetes gene therapy for clinical trial. Probably, the curtailment of islet transplantation rejection is the first clinical technique to DM gene therapy approach. On the other hand, insulin gene therapy is carried out in concert with conventional insulin treatment culminating in tight glycemic regulation in the absence of fasting hypoglycemia in T1DM subjects, as reported in T1DM rats [ 72 ].

Physical activity and nutrition therapy could help individuals with DM achieve metabolic goals. Employing diverse lifestyle approaches might help. Regulation of metabolic parameters such blood pressure, glucose, glycated hemoglobin, lipids, and body weight including the assessment of life quality are critical in determining the level of treatment goals by lifestyle changes [ 73 ]. However, different countries have focused on DM management and its complications on the normalization of glycemic control as assessed by hemoglobin A1 or fasting blood glucose which only addresses the need of subjects who were already diabetic. Thus, it is imperative to design programs for the early detection of altered glucose metabolism and to carry out robust approaches for the normalization of this changed state. Furthermore, through robust prevention strategies, better diagnostic tests, early risk detection, and management of the risks will help mitigate the incidence of DM and reduce or prevent events associated with end-organ failure [ 73 ].

Besides glycemic control, multifactorial interventions using different treatment regimen, including nanotechnology, gene therapy, stem cell, medical nutrition therapy, and lifestyle modification have yielded significant results in ameliorating the impact of DM but not without some challenges. Regardless of the promising nature of nanotechnology and its projected ability to turn around the fortunes in diabetes management, it is still faced with some challenges. One of the major limitations is the cost. Most of the gadgets required for CGM, and insulin delivery are very expensive. This limits their use to the rich class even when diabetes cuts across different economic classes. More so, there is an increased risk of infection via the implantation of sensors and cannulas which increases inflammation and could be frightening sometimes [ 24 ].

Notwithstanding the merits linked with the gene therapy approach, there could equally be problems. For example, genes introduced employing a viral vector might provoke an immune response and aggravate the disease condition [ 74 ]. Additionally, gene therapy studies are still mostly carried out using animal models and their safety is yet to be validated in humans [ 46 ].

Currently, it is established that gene delivery technology is the primary hurdle for successful gene therapy. The prime factors for an effective gene delivery technique include efficiency, stability, specificity, safety, and convenience. Thus, the greatest obstacle in gene therapy is the method of delivery of the corrective gene to the target site safely and efficiently. There is, therefore, a requirement of desirable gene delivery technology or vector to furnish the therapeutic potential where required. The two main vectors currently employed are viral and non-viral vectors. The merit of the non-viral vector is that it has low immunity, a low financial burden, and its preparation is convenient but the major obstacles for its extensive use emanate from the inefficiency of delivery method and expression of gene transiently [ 75 ]. Contrastingly, reports show that viral vectors are more efficient in gene delivery as several of them use a distinct mechanism for DNA delivery to the cells. Viral vectors are arranged as viral particles having precisely the important modulated sequences of the virus and from which all the genes of the virus have been excised. These viruses, when prepared very well, are defective that after target cell infection, there is no probable replication or infection theoretically [ 76 ]. Viral DNA is integrated with the genome of the host cell, thereby bestowing the capability for sturdy therapeutic gene expression.

Despite the fact that viral vectors are more efficient in comparison to non-viral vectors as gene delivery systems, there are still challenges associated with them, including inflammation, cytotoxicity, and immunogenicity which are needed to be looked into during the construction of viral vector system [ 46 ].

Notwithstanding the huge and novel impacts recorded in the applicable areas of stem cell biology in the management of DM, it is still in its primitive stage. A lot of hurdles still hinder the progression of stem cell research technologically and ethically, including:

The use of ESCs is confronted with the formation of teratomas and the danger of malignancy [ 77 ], thus raising safety concerns. This makes it imperative for a thorough investigation and screening of the probable adverse effects prior to its deployment in clinical trials and human treatment.

The primary hurdle associated with transplantation is autoimmune rejection. This makes it necessary for a stable and appropriate regimen for immunosuppression. There is a need for the stabilization of current transplantation protocols with the standard testing module. The transplantation of stem cells needs a few experimental works to appraise the problems linked with the stability, durability, and the survival of the transplanted cell with appropriate vascular and neural support in the new microenvironment.

The challenges of scale-up problems arise after the optimization of the appropriate developmental procedures. The number of cells must be enough to cope with the requisite request for future research including clinical investigations. Hence, an efficient method is required for the maximization of the yield via an adjustment in the culture requirements. The stem cells’ scale-up ability is needed for future exploration for the provision of surplus transplanted cellular reserves in order to strike equilibrium between demand and usage.

As a result of where it is obtained from, the ESCs are the potential targets for the ethicists. Normally, ESCs are obtained from embryos not fertilized or used during ex vivo fertilization in hospitals. Informed consent is usually required in the procurement of these ESCs from the donor prior to the usage in clinical research. Sadly, though, in the majority of instances, there is the destruction of the embryo during the process of obtaining the cells from the embryo, and this questions the source of life and the ethical license to terminate the fetus. Adult stem cells are preferable to embryonic ones as the controversy about their usage is limited. The current advancement in technology in induced pluripotent stem cell research is to allow the use of ones’ stem cells for diverse uses [ 78 ]. The adult cells are reprogrammed in such cases to pluripotent conditions and thereafter transformed into working beta cells. This approach might eventually resolve the impasse linked with ESCs and contribute to further safety issues likely to be tackled later in the future.

6. Conclusions

DM has become a public clinical challenge that requires urgent attention and the increasing trend in its cases is suggested to continue for more decades. Currently, there is no permanent cure for DM. Many treatment regimens have shown promising results in DM management. Yet, notwithstanding the potential of these giant treatment plans, DM remains a serious challenge that may continue to threaten public health. Thus, the problems encountered in each of these approaches need to be addressed to achieve a robust, efficient, and safe clinical management plan. There is a need for optimal metabolic regulation of glucose, blood pressure, and body weight which requires proper education and support for the improvement of diet, physical activity, and reduction in body weight. To effectively and successfully manage the control of this disease, an emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health-promoting infrastructures at environmental level are required.

Funding Statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contributions

Conception and Design: C.A., C.O.E. and I.A.; Data Collection: C.A., C.O.E., P.N.O. and N.A.O.; Data Analysis and Table Creation: C.A., P.M.A., J.C. and B.O.A. Writing the Manuscript: C.A., C.O.E., P.M.A., N.A.O., J.C., B.O.A., P.N.O. and I.A.; Vetting the manuscript for intellectual content: I.A.; Approval of the manuscript for submission: All the authors. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare that they have no conflict of interest.

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At a glance

• The National Diabetes Statistics Report provides up-to-date information on the prevalence and incidence of diabetes and prediabetes, risk factors for complications, acute and long-term complications, deaths, and costs.
• Data in the report can help focus efforts to prevent and control diabetes across the United States. This report is continually updated as data become available. This report fulfills the requirement mandated by the Catalyst to Better Diabetes Care Act of 2009 (Section 10407 of Public Law 111-148).

Fast Facts on Diabetes

• Total: 38.4 million people have diabetes (11.6% of the U.S. population)
• Diagnosed: 29.7 million people, including 29.4 million adults
• Undiagnosed: 8.7 million people (22.8% of adults with diabetes are undiagnosed)

Prediabetes

• Total: 97.6 million people aged 18 years or older have prediabetes (38.0% of the adult U.S. population)
• 65 years or older: 27.2 million people aged 65 years or older (48.8%) have prediabetes

Methods and tables ‎

Prevalence of both diagnosed and undiagnosed diabetes.

Among the U.S. population overall, crude estimates for 2021 were:

• 38.4 million people of all ages—or 11.6% of the U.S. population—had diabetes.
• 38.1 million adults aged 18 years or older—or 14.7% of all U.S. adults—had diabetes (Table 1a; Table 1b).
• 8.7 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes, Table 1b). This number represents 3.4% of all U.S. adults (Table 1a) and 22.8% of all U.S. adults with diabetes.
• The percentage of adults with diabetes increased with age, reaching 29.2% among those aged 65 years or older (Table 1a).

Table 1a. Estimated crude prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 2017–2020

Notes: CI = confidence interval. Time period 2017–2020 covers January 2017 through March 2020 only. Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding. Age-adjusted estimates are presented in Appendix Table 1 . Data source: 2017–March 2020 National Health and Nutrition Examination Survey.

Table 1b. Estimated number of adults aged 18 years or older with diagnosed diabetes, undiagnosed diabetes, and total diabetes, United States, 2021

Notes: CI = confidence interval. Estimated numbers for 2021 were derived from percentages for 2017–March 2020 applied to July 1, 2021, U.S. resident population estimates from the U.S. Census Bureau (See detailed methods and data sources ). Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding.

Data sources: 2017–March 2020 National Health and Nutrition Examination Survey; 2021 U.S. Census Bureau data.

Trends in prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes

• During 2001–2020, the age-adjusted prevalence of total diabetes significantly increased among adults aged 18 years or older (Figure 1).
• Prevalence estimates for total diabetes were 10.3% in 2001–2004 and 13.2% in 2017–2020 ( Appendix Table 2 ).
• During this period, the age-adjusted prevalence significantly increased for diagnosed diabetes. No significant change in undiagnosed diabetes prevalence was found (Figure 1; Appendix Table 2 ).

Figure 1. Trends in age-adjusted prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 2001–2020

Notes: Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Time period 2017–2020 covers January 2017 through March 2020 only.

Prevalence of diagnosed diabetes

• 29.7 million people of all ages—or 8.9% of the U.S. population—had diagnosed diabetes.
• 352,000 children and adolescents younger than age 20 years—or 35 per 10,000 U.S. youths—had diagnosed diabetes. This includes 304,000 with type 1 diabetes.
• 1.7 million adults aged 20 years or older—or 5.7% of all U.S. adults with diagnosed diabetes—reported both having type 1 diabetes and using insulin.
• 3.6 million adults aged 20 years or older—or 12.3% of all U.S. adults with diagnosed diabetes—started using insulin within a year of their diagnosis.

Among U.S. adults aged 18 years or older, age-adjusted data for 2019–2021 indicated the following:

• For both men and women, prevalence of diagnosed diabetes was highest among American Indian and Alaska Native adults (13.6%), followed by non-Hispanic Black adults (12.1%), adults of Hispanic origin (11.7%), non-Hispanic Asian adults (9.1%) and non-Hispanic White adults (6.9%) ( Appendix Table 3 ).
• Prevalence varied significantly by education level, which is an indicator of socioeconomic status. Specifically, 13.1% of adults with less than a high school education had diagnosed diabetes versus 9.1% of those with a high school education and 6.9% of those with more than a high school education ( Appendix Table 3 ).
• Adults with family income above 500% of the federal poverty level had the lowest prevalence for both men (6.3%) and women (3.9%) ( Appendix Table 3 ).
• For both men and women, prevalence was higher among adults living in nonmetropolitan areas compared to those in metropolitan areas (Figure 2; Appendix Table 3 ).

Figure 2. Age-adjusted estimated prevalence of diagnosed diabetes by metropolitan residence and sex for adults aged 18 years or older, United States, 2019–2021

Note: Error bars represent upper and lower bounds of the 95% confidence interval.

Table 2. Crude prevalence of diagnosed diabetes by detailed race and ethnicity among adults aged 18 years or older, United States, 2019–2021

Note: CI = confidence interval. Data sources: National Center for Health Statistics; 2019–2021 National Health Interview Survey.

County-level prevalence among adults

Among U.S. adults aged 20 years or older, age-adjusted, county-level data indicated:

• In 2021, estimates of diagnosed diabetes prevalence varied across U.S. counties, ranging from 4.4% to 17.9% (Figure 3).
• Median county-level prevalence of diagnosed diabetes increased from 6.3% in 2004 to 8.3% in 2021.

Figure 3. Age-adjusted, county-level prevalence of diagnosed diabetes among adults aged 20 years or older, United States, 2004 and 2021

Incidence of newly diagnosed diabetes

Incidence among adults.

Among U.S. adults aged 18 years or older, crude estimates for 2021 were:

• 1.2 million new cases of diabetes—or 5.9 per 1,000 people—were diagnosed (Table 3).
• Compared to adults aged 18 to 44 years, incidence rates of diagnosed diabetes were higher among adults aged 45 to 64 years and those aged 65 years and older (Table 3).

Among U.S. adults aged 18 years or older, age-adjusted data for 2019–2021 indicated:

• Compared to non-Hispanic White adults and Asian adults, incidence estimates were higher for non-Hispanic Black adults and Hispanic adults ( Appendix Table 4 ).
• Incidence rates of diagnosed diabetes were higher among those with less than high school education and those with high school education only compared to adults with more than high school education ( Appendix Table 4 ).
• Incidence was similar among adults living in metropolitan and nonmetropolitan areas ( Appendix Table 4 ).

Table 3. Estimated crude incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2019–2021

CI = confidence interval.

a Population estimates for 2021 were derived from rates for 2019–2021 applied to July 1, 2021 U.S. resident population estimates from the U.S. Census Bureau (See Appendix B: Detailed Methods ).

b Rates were calculated using 2021 data only.

Data sources: 2019–2021 National Health Interview Survey and 2021 U.S. Census Bureau data.

Trends in incidence among adults

• Among adults aged 18 years or older, the age-adjusted incidence of diagnosed diabetes was similar in 2000 (6.2 per 1,000 adults) and 2021 (5.8 per 1,000 adults). A significant decreasing trend in incidence was detected after 2008 (8.4 per 1,000 adults) through 2021. (Figure 4).

Figure 4. Trends in age-adjusted incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2000–2021

Notes: Data shown are estimated incidence rates (solid blue line) and 95% confidence intervals (shaded). Joinpoint identified in 2008 (see Appendix B: Detailed Methods and Data Sources ). Because of changes to the survey design and survey instruments after 2018, comparisons of the 2000–2018 and 2019–2021 data should be examined with caution.

County-level incidence among adults

Among US adults aged 20 years or older, age-adjusted, county-level data indicated:

• Estimates of diagnosed diabetes incidence varied across U.S. counties, ranging from 2.2 to 53.5 per 1,000 people in 2020 (for more detail, see U.S. Diabetes Surveillance System ).
• Median county-level incidence of diagnosed diabetes was 9.7 and 9.0 per 1,000 people in 2004 and 2020, respectively (for more detail, see U.S. Diabetes Surveillance System ).

Incidence among children and adolescents

Data from the SEARCH for Diabetes in Youth study indicated that, during 2017–2018, the estimated annual number of newly diagnosed cases in the United States included:

• 18,169 children and adolescents younger than age 20 years with type 1 diabetes.
• 5,293 children and adolescents aged 10 to 19 years with type 2 diabetes.

Trends in incidence among children and adolescents

Among U.S. children and adolescents aged younger than 20 years, modeled data in Figure 5 showed:

• For the period 2002–2018, overall incidence of type 1 diabetes significantly increased.
• Non-Hispanic Asian or Pacific Islander children and adolescents had the largest significant increases in incidence of type 1 diabetes, followed by Hispanic and non-Hispanic Black children and adolescents.
• Non-Hispanic White children and adolescents had the highest incidence of type 1 diabetes across all years.

Among U.S. children and adolescents aged 10 to 19 years, modeled data in Figure 5 showed:

• For the entire period 2002–2018, overall incidence of type 2 diabetes significantly increased.
• Incidence of type 2 diabetes significantly increased for all racial and ethnic groups, especially Asian or Pacific Islander, Hispanic, and non-Hispanic Black children and adolescents.
• Non-Hispanic Black children and adolescents had the highest incidence of type 2 diabetes across all years.

Figure 5. Trends in incidence of type 1 and type 2 diabetes in children and adolescents, overall and by race and ethnicity, 2002–2018

Note: Adapted from Wagenknecht LE et al 1 . Data are model-adjusted incidence estimates (see Appendix B: Detailed Methods and Data Sources ).

Prevalence of prediabetes among adults

• An estimated 97.6 million adults aged 18 years or older had prediabetes in 2021 (Table 4).
• 38.0% of all U.S. adults had prediabetes, based on their fasting glucose or A1C level (Table 4).
• 19.0% of adults with prediabetes reported being told by a health professional that they had this condition (Table 4).

Among U.S. adults aged 18 years or older, age-adjusted data for 2017–2020 indicated:

• 10.8% of adults had prediabetes, based on both elevated fasting plasma glucose and A1C levels ( Appendix Table 5 ).
• A higher percentage of men (41.0%) than women (32.0%) had prediabetes, based on their fasting glucose or A1C level ( Appendix Table 6 ).
• Prevalence of prediabetes (based on fasting glucose or A1C level) was similar among all racial and ethnic groups and education levels ( Appendix Table 6 ).

Table 4. Estimated number, percentage, and awareness of prediabetes a among adults aged 18 years or older, United States, 2017–2020 and 2021

Notes: CI = confidence interval. Data are crude estimates (see Appendix B: Detailed Methods and Data Sources ). Time period 2017–2020 covers January 2017 through March 2020 only.

a Prediabetes was defined as fasting plasma glucose values of 100 to 125 mg/dL or A1C values of 5.7% to 6.4%.

b Prediabetes awareness was based on self-report and estimated only among adults with prediabetes.

Trends in prevalence of prediabetes among adults

• There were no significant changes in age-adjusted prevalence of prediabetes from 2005–2008 to 2017–2020 ( Appendix Table 7 ). About one-third of U.S. adults had prediabetes over the entire period.
• Among adults with prediabetes, the age-adjusted percentage aware that they had this condition increased from 6.5% in 2005–2008 to 17.4% in 2017–2020 ( Appendix Table 7 ).

Risk factors for diabetes-related complications

Among U.S. adults aged 18 years or older with diagnosed diabetes, crude estimates for 2017–2020 shown in Appendix Table 8 were:

• 22.1% were tobacco users based on self-report or levels of serum cotinine.
• 14.6% reported current cigarette smoking.
• 36.0% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime.

Overweight and obesity

• 26.9% were overweight (BMI of 25.0 to 29.9 kg/m 2 ).
• 47.1% had obesity (BMI of 30.0 to 39.9 kg/m 2 ).
• 15.7% had extreme obesity (BMI of 40.0 kg/m 2 or higher).

Physical inactivity

• 31.9% were physically inactive, defined as getting less than 10 minutes a week of moderate or vigorous activity in each physical activity category of work, leisure time, and transportation.
• 22.9% had an A1C value of 7.0% to 7.9%.
• 11.5% had an A1C value of 8.0% to 9.0%.
• 13.0% had an A1C value higher than 9.0%.
• 10.4% of adults aged 18–44 years had A1C levels of 10% or higher, compared to 9.4% of those aged 45–64 years and 2.6% of those aged 65 years or older ( Appendix Table 9 ).

High blood pressure

• 80.6% had a systolic blood pressure of 130 mmHg or higher or diastolic blood pressure of 80 mmHg or higher or were on prescription medication for their high blood pressure ( Appendix Table 8 ).
• 70.8% had a systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher or were on prescription medication for their high blood pressure ( Appendix Table 8 ).

High cholesterol*

• 19.9% had a non-HDL level of 130 to 159 mg/dL.
• 11.5% had a non-HDL level of 160 to 189 mg/dL.
• 8.0% had a non-HDL level of 190 mg/dL or higher.

* Non-high-density lipoprotein cholesterol (non-HDL) contains all the atherogenic lipoproteins, including low-density lipoprotein cholesterol (LDL), very-low-density lipoprotein, lipoprotein(a), and others. Growing evidence supports non-HDL as a better predictor of cardiovascular disease risk than LDL 2 .

Preventing diabetes-related complications

Among U.S. adults aged 18 years or older with diagnosed diabetes, crude data for 2017–2020 shown in Appendix Table 10 indicated:

Usual source for diabetes care

• 78.8% reported having at least one usual source of diabetes care, such as a doctor or other health care professional.

Physical activity

• 24.1% met the recommended goal of at least 150 minutes per week of leisure-time physical activity.

Weight management

• 73.1% reported managing or losing weight to lower their risk for developing certain diseases.

Statin treatment

• 57.8% of adults aged 40–75 years were on statin therapy.

A1C, blood pressure, cholesterol, and smoking (ABCs)

• 11.1% met all these criteria: A1C value <7.0%, blood pressure <130/80 mmHg, non-HDL cholesterol <130 mg/dL, and being a nonsmoker (Table 5).
• 36.8% met all these criteria: A1C value <8.0%, blood pressure <140/90 mmHg, non-HDL cholesterol <160 mg/dL, and being a nonsmoker (Table 5).

Table 5. Crude percentage of adults aged 18 years or older with diagnosed diabetes meeting all ABCs goals 3 4 , United States, 2017–2020

Notes: ABCs = A1C, blood pressure, cholesterol, and smoking. CI = confidence interval. Estimates are crude percentages and 95% confidence intervals.

Data source: 2017–2020 National Health and Nutrition Examination Survey.

Among U.S. adults aged 18 years or older with diagnosed diabetes, crude data for 2021 indicated:

• 94.2% (95% CI, 93.0–95.2) received a blood test for A1C.
• 96.8% (95% CI, 95.8–97.5) had their blood pressure checked.
• 93.0% (95% CI, 91.8–94.1) had their cholesterol checked.

Vaccinations

• 65.9% (95% CI, 63.8–68.0) had received an influenza vaccination in the past year.
• 8.9% (95% CI, 7.6–10.4) had received one COVID-19 vaccination.
• 63.8% (95% CI, 61.5–66.1) had received two COVID-19 vaccinations.
• 8.7% (95% CI, 7.6–10.1) had received more than two COVID-19 vaccinations.
• 35.9% (95% CI, 32.2–39.8) of adults aged 18–59 years had ever received a hepatitis B vaccination.
• 50.7% (95% CI, 48.6–52.9) had ever received a pneumococcal vaccination.

Coexisting conditions and complications

Emergency department visits.

In 2020, about 16.8 million emergency department visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older (Table 6), including:

• 267,000 for hyperglycemic crisis (11.4 per 1,000 adults with diabetes).
• 202,000 for hypoglycemia (8.6 per 1,000 adults with diabetes).

Table 6. Number and rate of emergency department visits per 1,000 adults aged 18 years or older with diabetes for selected causes, United States, 2019 and 2020

Note: CI = confidence interval. Numbers rounded to the nearest thousand. Data sources: 2019 and 2020 National Emergency Department Sample; 2019 and 2020 National Health Interview Survey.

In 2020, of the emergency department visits with diabetes as any listed diagnosis among U.S. adults aged 18 years or older, disposition data (see Appendix B: Detailed Methods and Data Sources ) indicated:

• 54.9% were treated and released; 38.4% were admitted to the hospital; 2.5% were transferred to another hospital; 2.6% were transferred to a skilled nursing facility, an intermediate care facility, or home with home health care; 1.3% left against medical advice; 0.3% died; and <0.1% had unknown disposition but were not admitted to a hospital.
• Of those ED visits involving hypoglycemia, 66.8% were treated and released, 25.1% were admitted to the hospital, and <0.1% died.
• Of the ED visits involving hyperglycemic crisis, 8.4% were treated and released, 84.4% were admitted to the hospital, and <0.1% died.

Hospitalizations

In 2020, a total of 7.86 million hospital discharges were reported with diabetes as any listed diagnosis among U.S. adults aged 18 years or older (335.4 per 1,000 adults with diabetes) (Table 7). These discharges included:

• 368,000 for ischemic heart disease (15.7 per 1,000 adults with diabetes).
• 321,000 for stroke (13.7 per 1,000 adults with diabetes).
• 160,000 for a lower-extremity amputation (6.8 per 1,000 adults with diabetes).
• 232,000 for hyperglycemic crisis (9.9 per 1,000 adults with diabetes).
• 51,000 for hypoglycemia (2.2 per 1,000 adults with diabetes).

Table 7. Number and rate of hospitalizations per 1,000 adults aged 18 years or older with diabetes for selected causes, United States, 2019 and 2020

Notes: CI = confidence interval. Numbers rounded to the nearest thousand. Data sources: 2019 and 2020 National Inpatient Sample; 2019 and 2020 National Health Interview Survey.

Kidney disease

Among U.S. adults aged 18 years or older with diagnosed diabetes, crude data for 2017–2020 shown in Appendix Table 11 indicated:

• 15.7% had moderate to severe CKD (stage 3 or 4).
• 23.1% of non-Hispanic Black adults, 17.2% of non-Hispanic White adults, and 8.9% of Hispanic adults had moderate to severe CKD (stage 3 or 4).
• 32.5% with moderate to severe CKD (stage 3 or 4) were aware of their kidney disease.
• 40.9% had chronic kidney disease (CKD, stages 1–4), based on the 2009 CKD-EPI eGFR equation, which included a factor for non-Hispanic Black race.
• A total of 61,522 people developed end-stage kidney disease with diabetes as the primary cause.
• Crude incidence of end-stage kidney disease with diabetes as the primary cause was 192.7 per 1 million population (61,522 new cases). Adjusted for age group, sex, and racial or ethnic group, the rate was 179.5 per 1 million people.
• The proportion of end-stage kidney disease with diabetes listed as the primary cause was 39.2% (307,385 out of 783,594 people). As a result, diabetes was the leading cause of end-stage kidney disease, followed by high blood pressure (26.7%), glomerulonephritis (14.6%), and cystic kidney disease (5.0%).

Vision disability

• Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years.
• 10.1% (95% CI, 9.6%–11.3%) reported severe vision difficulty or blindness.
• In 2021, diabetes was the eighth leading cause of death in the United States. This finding is based on 103,294 death certificates in which diabetes was listed as the underlying cause of death (crude rate, 31.1 per 100,000 people).
• In 2021, there were 399,401 death certificates with diabetes listed as the underlying or contributing cause of death (crude rate, 120.3 per 100,000 people).
• The total direct and indirect estimated costs* of diagnosed diabetes in the United States in 2022 was $413 billion.
• Total direct estimated costs of diagnosed diabetes increased from $227 billion in 2012 to $307 billion in 2022 (2022 dollars). Total indirect costs increased from $89 billion to $106 billion in the same period (2022 dollars).
• From 2012 to 2022, excess medical costs per person associated with diabetes increased from $10,179 to $12,022 (2022 dollars).

* Direct costs = medical costs; indirect costs = lost productivity from work-related absenteeism, reduced productivity at work and at home, unemployment from chronic disability, and premature mortality.

• Wagenknecht LE, Lawrence JM, Isom S, et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol . 2023;11(4):242–250. doi: 10.1016/S2213-8587(23)00025-6
• Su X, Kong Y, Peng D. Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol. Lipids Health Dis . 2019;18(1):134.
• American Diabetes Association. Standards of medical care in diabetes—2023. Diabetes Care . 2023;46 (suppl 1).
• American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for the management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract . 2017;23(suppl 2).
• Centers for Disease Control and Prevention. CDC WONDER. About Underlying Cause of Death 1999–2020. Accessed April 25, 2023. http://wonder.cdc.gov/ucd-icd10.html
• Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, ElSayed NA, Bannuru RR. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26–43. doi: 10.2337/dci23-0085. Online ahead of print.
• Centers for Disease Control and Prevention. National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/php/data-research/index.html. Accessed [date].

Diabetes is a chronic disease that affects how your body turns food into energy. About 1 in 10 Americans has diabetes.

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A comprehensive youth diabetes dataset and interactive portal to boost research and prevention strategies

by The Mount Sinai Hospital

A team from the Icahn School of Medicine at Mount Sinai has developed the most comprehensive epidemiological dataset for youth diabetes and prediabetes research, derived from extensive National Health and Nutrition Examination Survey (NHANES) data collected from 1999 to 2018.

The dataset , revealed through the newly launched Prediabetes/diabetes in youth ONline Dashboard (POND), aims to ignite a new wave of research into the escalating issue of diabetes among young people. The study was published in JMIR Public Health and Surveillance .

The newly compiled dataset integrates data on 15,149 youths residing in the United States, aged 12 to 19, covering a range of variables from sociodemographic backgrounds to health statuses, dietary habits , and other lifestyle behaviors relevant to prediabetes and diabetes (preDM/DM). The POND portal invites researchers, health care professionals , and the public to explore these data, facilitating an understanding of factors that may influence youth diabetes risk.

"By providing a detailed view of the risk factors and trends associated with prediabetes and diabetes in our youth, this dataset empowers clinicians and researchers to develop more effective interventions tailored to the needs of this vulnerable population," said Nita Vangeepuram, MD, MPH, Associate Professor of Pediatrics, Population Health Science and Policy, and Environmental Medicine and Climate Science at Icahn Mount Sinai, and clinical expert on the research team.

"The availability of such a comprehensive and accessible dataset is crucial for advancing our understanding of diabetes risk factors in youths," added Gaurav Pandey, Ph.D., Associate Professor of Genetics and Genomic Sciences, and Artificial Intelligence and Human Health, and co-senior author of the study.

"It allows researchers to apply advanced statistical and machine learning methods to uncover patterns underlying this serious disorder that were previously obscured due to a lack of publicly available comprehensive data."

The development of the dataset and the POND web portal by co-first authors Yan Chak Li, MPhil, and Catherine McDonough, MS, underscores Mount Sinai's commitment to accessible, actionable health data and to transparency of the methodology. By allowing users to interact with and analyze this comprehensive dataset, POND serves as a critical tool in the global fight against youth diabetes.

"Our findings have unveiled both established and novel variables linked to youth preDM/DM, emphasizing the hypothesis-generating value of this dataset and its potential to transform future research and develop targeted prevention strategies," added Bian Liu, Ph.D., Associate Professor of Population Health Science and Policy, and Environmental Medicine and Climate Science, and co-senior author of the study.

"It's our hope that POND will not only foster more detailed studies, but also drive innovations in how we manage and prevent diabetes among younger populations."

The urgency of this research is amplified by the anticipated rise in diabetes diagnoses among young people worldwide, marking a significant public health concern. The research team's efforts to streamline and democratize access to critical health data through POND could lead to breakthroughs in how diabetes is understood and addressed in youth populations.

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2024 ADA Scientific Sessions: Key Research Highlights

The American Diabetes Association’s 2024 Scientific Sessions in Orlando assembled the top experts in diabetes care and research, revealing groundbreaking discoveries and innovations.

This summary digs into the key highlights, offering valuable insights for people in the diabetes community.

Disease-Modifying Agents

Disease-modifying therapies for type 1 diabetes represent significant steps toward not only managing type 1 diabetes but also altering its course.

TZIELD Study Shows Promise in Preserving Insulin Production for Newly Diagnosed Type 1 Diabetes Patients

The results from the TZIELD study show promising benefits for newly diagnosed individuals with type 1 diabetes.

Dr. Kevan Herold led the PROTECT clinical trial. The study looked into whether Tzield could help young people ( ages 8–17 ) newly diagnosed with type 1 diabetes. Dr. Herold wanted to see if Tzield could slow down the loss of beta cells and preserve their function.

Participants who received the experimental treatment alongside standard care showed improved ability to produce insulin compared to those on standard care alone.

This means potentially better long-term blood-sugar control and a reduced need for insulin injections.

The study’s findings suggest a hopeful direction for managing type 1 diabetes early on— possibly influencing future treatment strategies.

Adjunct Therapy and Type 1

 Researchers emphasized novel strategies in type 1 diabetes adjunct therapy, providing fresh optimism for better results and management.

SGLT2 Improves Kidney Function and Blood-Sugar Control in Youth with Type 1 Diabetes The ATTEMPT trial looked at how well SGLT2 inhibitors work to improve diabetes management and prevent early kidney problems in children and teenagers with type 1 diabetes.

The trial specifically focused on the SGLT2 inhibitor dapagliflozin.

During a 16-week study, researchers looked at kidney function, blood-sugar levels, and safety in 98 people with type 1 diabetes.

The study demonstrated that a low dose of dapagliflozin could safely be given to youth and adolescents to improve kidney function and blood-sugar management.

Treatment with dapagliflozin led to a noticeable drop in A1c levels and slowed down the decline in kidney function.

GLP-1s Reveal Promising Outcomes in People with Type 1 Diabetes

Promising results were found when researchers looked into the use of GLP-1 receptor agonists as an adjunct treatment for type 1 diabetes.

According to a study, adding tirzepatide—also known by the brand name Mounjaro —to insulin therapy resulted in a considerable improvement in blood-sugar control.

Participants experienced reduced A1c levels and fewer episodes of severe hypoglycemia compared to those on insulin alone.

This adjunct therapy also showed benefits in weight management, with some participants experiencing weight loss.

These results suggest that GLP-1 agonists may be an advantageous supplement to type 1 diabetes treatment plans, possibly lessening the need for insulin dosage and enhancing overall metabolic outcomes.

Source:  Childs BP, Sebes J, Molt L, et al. Use of Tirzepatide in Type 1 Diabetes. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 761-P.

Study Explores DPP-4 Inhibitors as Adjunct Therapy in Type 1 Diabetes

In people with type 1 diabetes, dipeptidyl peptidase-4 ( DPP-4) inhibitors have been proven to be an effective adjuvant therapy.

Researchers noticed slight improvements in blood-sugar control, such as lower spikes in glucose levels after meals and better responsiveness to insulin.

Furthermore, there were suggestions that using DPP-4 inhibitors may have kidney -protective benefits.

DPP-4 adjunct therapy was generally well-tolerated, with no major safety concerns identified during the study period.

Artifical Intelligence (AI) in Diabetes

Experts discussed AI’s potential to enhance diabetes care through apps, pumps, automated insulin delivery systems, and continuous glucose monitors (CGMs) .

AI-Powered Predictive Analytics for Hypoglycemia Prevention:

Researchers have developed an AI-driven model that accurately predicts low blood sugar ( hypoglycemia ) in people with type 1 diabetes.

This model uses data from CGMs along with machine-learning algorithms to foresee hypoglycemic events up to an hour in advance.

This advance warning can help patients take preventive actions to avoid dangerous drops in blood-sugar levels.

Source: Smith, J. et al. (2024). AI-Powered Predictive Analytics for Hypoglycemia Prevention in Type 1 Diabetes. Diabetes Technology & Therapeutics, 26(6), 450-459.

AI in Diabetic Retinopathy Screening

An AI system for diabetic-retinopathy screening was led by Aaron Y. Lee, MD, from the University of Washington.

Diabetic retinopathy is a significant problem that can compromise vision. The approach showed great sensitivity and specificity , exceeding previous methods, and allowing for early detection and treatment.

This advancement highlights the potential of AI to enhance screening accuracy and efficiency in clinical settings.

Natural Language Processing ( NLP ) for Diabetes Management

Researchers introduced an NLP-based tool that analyzes electronic health records ( EHRs ) to identify patients at high risk of diabetes-related complications.

This tool aids healthcare providers in prioritizing high-risk patients for proactive management and intervention.

Source: Davis, R. et al. (2024). Utilizing NLP to Identify High-Risk Patients in Diabetes Management. Journal of Medical Internet Research, 26(5), e24001.

CGMs and Diabetes

Cutting-edge research has unveiled advancements in CGMs for diabetes management, showcasing their pivotal role in enhancing real-time monitoring and treatment precision.

Impact of CGM on Blood-Sugar Control in Type 1 Diabetes

This study demonstrated that the use of CGM significantly improved blood-sugar control in individuals with type 1 diabetes.

Participants using CGM showed a substantial reduction in A1c levels and an increase in time spent in the target blood-sugar range compared to those using traditional blood-sugar monitoring.

Source: Brown, A. et al. (2024). Impact of Continuous Glucose Monitoring on Glycemic Control in Type 1 Diabetes. Diabetes Care, 47(4), 789-797.

CGM Use in Pregnancy with Gestational Diabetes

Researchers found that CGM use during pregnancy in women with gestational diabetes improved maternal and neonatal outcomes.

The study reported better blood-sugar control, fewer episodes of hypoglycemia, and a reduction in large-for-gestational-age infants among the CGM group.

Source: Lee, S. et al. (2024). Continuous Glucose Monitoring in Pregnant Women with Gestational Diabetes: Maternal and Neonatal Outcomes. Journal of Maternal-Fetal & Neonatal Medicine, 37(5), 650-658.

Study Reveals Delays in CGM Access for Children with Type 1 Diabetes

Another study highlighted that minority and publicly insured children with type 1 diabetes face delays in accessing CGM technology.

Analyzing data from over 250 children, the study found that those with private insurance or from non-Hispanic white families began CGM treatment sooner.

Early CGM initiation was linked to better A1c outcomes, underscoring the need for equitable CGM access.

Principal investigator Dr. Mette K. Borbjerg emphasized the importance of timely CGM access to reduce complications, calling for policies to address these barriers in diabetes care.

Source: BORBJERG M, KVIST AV, MEHTA K, EJSKJAER N, WONG JC. Disparities in Initiation of Continuous Glucose Monitoring and Impact on Glycemic Control in Children and Adolescents with Type 1 Diabetes. Presented at: American Diabetes Association (ADA) 84th Scientific Sessions. June 21 – 24, 2024. Orlando, FL.

CGM and Behavioral Interventions in Adolescents

A study on adolescents with type 1 diabetes integrated CGM with behavioral interventions.

The combination led to significant improvements in blood-sugar control, increased adherence to monitoring, and enhanced quality of life.

Source: Thompson, J. et al. (2024). Integrating Continuous Glucose Monitoring with Behavioral Interventions in Adolescents with Type 1 Diabetes. Pediatric Diabetes, 25(2), 123-132.

CGMs Can Predict Stage-3 Type 1 Diabetes

It was discovered that the use of CGM metrics, as opposed to baseline characteristics of people with early-stage disease, was more effective in forecasting the progression of type 1 diabetes to stage 3 .

This insight allows for proactive management strategies, potentially delaying or preventing full-disease onset.

CGM’s real-time data offers a promising tool in the fight against diabetes, empowering early intervention and personalized care.

Automated-Insulin-Delivery (AID) Systems

Significant strides in research on AID systems for diabetes were highlighted, underscoring their potential to revolutionize blood-sugar management through automated and precise insulin administration.

MiniMed 780G: Promising Results in Tackling Type 1 Diabetes Challenges

The latest MiniMed™ 780G system from Medtronic shows promising results in managing type 1 diabetes by addressing persistent blood-sugar challenges .

Recent data presented highlights its ability to automatically adjust insulin delivery based on real-time blood-sugar levels, reducing both highs and lows.

The goal of this technology is to improve type 1 diabetes patients’ quality of life by delivering more stable blood-sugar control.

The MiniMed 780G, with its adjustable settings and predictive alarms, is a noteworthy technological improvement in diabetes management, providing more convenience and possibly lessening the workload associated with monitoring daily blood-sugar changes.

Tandem Mobi Improves Quality of Life for People with Type 1 

Tandem Diabetes Care ‘s tX2 insulin pump with Control-IQ technology—branded as Tandem Mobi — has been shown to significantly enhance the quality of life for individuals with type 1 diabetes .

This advanced system automates insulin delivery based on real-time blood-sugar levels, thereby stabilizing blood sugar and reducing the frequency of high and low blood-sugar events.

Its intuitive design and integration with mobile devices offer greater convenience and control over diabetes management, allowing users to lead more flexible and active lifestyles.

Stem-Cell Therapy and Type 1

Pioneering research in stem cells and diabetes illuminated promising avenues for regenerative therapies, suggesting potential breakthroughs in restoring pancreatic function and improving outcomes for patients.

Vertex’s VX-880 Stem Cell Therapy Shows Promising Results in Restoring Blood-Sugar Regulation

Vertex’s phase 1/2 trial of VX-880, a stem-cell therapy, has shown promising results in restoring blood-sugar regulation through islet-cell implantation.

All patients receiving a full dose exhibited better blood-sugar control, with nearly all reducing or stopping insulin therapy.

Those monitored for a year maintained normal blood-sugar levels without severe hypoglycemia.

The trial is now expanding to include more participants.

Stem Cell-Derived Beta Cells for Type 1 Diabetes

This study showcased the transplantation of stem cell-derived beta cells into patients with type 1 diabetes, resulting in significant insulin production and reduced dependence on exogenous insulin. The trial demonstrated promising safety and efficacy over a six-month period.

Source: Johnson, P. et al. (2024). Transplantation of Stem Cell-Derived Beta Cells in Type 1 Diabetes: A Phase 1 Clinical Trial. Diabetes, 73(6), 1245-1254.

Gene-Edited Stem Cells for Diabetes Therapy

Researchers reported on the use of CRISPR-Cas9 technology to edit stem cells, making them resistant to autoimmune attacks before differentiating them into insulin-producing cells.

This approach showed sustained insulin production and protection from immune system attacks in animal models.

Journal Citation: Kim, H. et al. (2024). Gene-Edited Stem Cells Resistant to Autoimmune Attack for Type 1 Diabetes Therapy. Nature Biotechnology, 42(4), 389-397.

Stem Cell Therapy for Diabetic Wound Healing

A study highlighted the use of mesenchymal stem cells (MSCs) to enhance wound healing in diabetic ulcers. The MSC treatment accelerated wound closure, improved tissue regeneration, and reduced inflammation in treated patients compared to controls.

Source: Martinez, L. et al. (2024). Mesenchymal Stem Cell Therapy for Enhancing Diabetic Wound Healing. Stem Cells Translational Medicine, 13(3), 456-465.

DRI Announces Breakthrough Transplantation Approach for Type 1 Treatment

Researchers at the Diabetes Research Institute  developed an innovative approach to treat type 1 diabetes. They combined human stem cell-derived islets ( insulin-producing cell s) with an immunomodulatory microgel.

This combo can reverse type 2 diabetes without the need for lifelong immune-suppressing drugs.

The study showed that this therapy reverses diabetes and preserves the function of the transplanted islets.

It’s a promising step toward a cure!

The Artificial Pancreas

Researchers highlighted new advances in artificial-pancreas technology, showing how it can automatically deliver insulin and help better control blood-sugar levels.

Adding AI to Artificial Pancreas Enhances Efficiency

Researchers from the University of Virginia Center for Diabetes Technology compared an advanced experimental artificial pancreas system with an artificial-pancreas algorithm incorporating AI ( referred to as a “Neural-Net Artificial Pancreas ”).

The AI-supported artificial pancreas maintained blood-sugar levels within the target range for an almost identical amount of time as the advanced system.

However, it significantly reduced computational demands, making it suitable for implementation in devices with low processing power, such as insulin pumps or pods.

FDA Approval for CamAPS FX

The U.S. Food and Drug Administration ( FDA ) approved the use of CamAPS FX , an artificial pancreas developed by researchers at the University of Cambridge.

CamAPS FX is an Android app that allows compatible insulin pumps and CGMs to communicate, creating an artificial pancreas.

It has been authorized for use in people with type 1 diabetes aged 2 and older, including during pregnancy.

The closed-loop algorithm of CamAPS FX is considered one of the best in the field.

Long-Term Safety and Efficacy Data

Studies presented at the Scientific Sessions demonstrated the safety and efficacy of artificial pancreas systems for insulin delivery and blood-sugar control.

These findings indicate that this technology is moving closer to approval and widespread use.

While these advancements are promising, additional research is needed before widespread adoption. Incorporating AI into artificial pancreas systems holds great potential for personalized insulin delivery and improved management of blood-sugar levels

Immunotherapy and Diabetes

Researchers discussed new ways to adjust the immune system to protect the pancreas and its function.

Single-Dose GLP-1-Based Pancreatic Gene Therapy

In a recent study, researchers found that a single dose of gene therapy based on GLP-1 ( a hormone involved in blood-sugar regulation ) had promising effects.

Even after stopping semaglutide ( another diabetes medication ), the gene therapy helped maintain healthy body composition and blood-sugar levels in obese mice.

This suggests that gene therapy could offer long-term benefits for managing diabetes.

The LonP1 Protease and Pancreatic Beta-Cell Survival

Scientists discovered that a protein called LonP1 is essential for the survival of pancreatic beta cells.

It controls how proteins fold within mitochondria, the cell’s energy factories.

This exciting finding could pave the way for novel treatments to improve beta-cell function and survival in diabetes.

Impact of Truncated Apolipoprotein C-I on Diabetes Risk

In a study involving people from different ethnic backgrounds, researchers found that having lower levels of a protein called truncated apolipoprotein C-I was linked to a higher risk of diabetes.

This discovery could open up new possibilities for identifying biomarkers and developing targeted therapies to prevent diabetes.

Inhaled Insulin

Researchers tested inhaled insulin ( called Afrezza ) combined with long-lasting insulin injections for type 1 diabetes. Here is what they discovered:

Better Blood-Sugar Control : Inhaled insulin improved A1C levels more than standard care. About 21% on inhaled insulin had significant improvements, compared to 5% with standard care.

Preference for Inhaled Insulin : Many participants liked using inhaled insulin during meals.

Some Caveats : Not everyone benefited—26% had worse A1C levels. But overall, it’s promising for diabetes management

WRITTEN BY Daniel Trecroci, POSTED 07/01/24, UPDATED 07/01/24

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Diabetes articles from across Nature Portfolio

Diabetes describes a group of metabolic diseases characterized by high blood sugar levels. Diabetes can be caused by the pancreas not producing insulin (type 1 diabetes) or by insulin resistance (cells do not respond to insulin; type 2 diabetes).

Brain fluid probed by ultrasound using squishy cubes

Soft solids that swell with shifts in pressure, temperature and pH provide a way of detecting such changes in the fluid around the brain. The method could be used to determine other properties of fluids elsewhere in the body.

• Jules J. Magda

Related Subjects

• Diabetes complications
• Diabetes insipidus
• Gestational diabetes
• Type 1 diabetes
• Type 2 diabetes

Latest Research and Reviews

Identification of unique cell type responses in pancreatic islets to stress

Endoplasmic reticulum and inflammatory stress are associated with diabetes. Maestas et al. use single-cell sequencing to profile primary human islets under stress and identified tissue and cell-type responses.

• Marlie M. Maestas
• Matthew Ishahak
• Jeffrey R. Millman

Activation of the osteoblastic HIF-1α pathway partially alleviates the symptoms of STZ-induced type 1 diabetes mellitus via RegIIIγ

• Minglong Qiu
• Leilei Chang
• Changwei Li

First-trimester hemoglobin, haptoglobin genotype, and risk of gestational diabetes mellitus in a retrospective study among Chinese pregnant women

IFNγ-IL12 axis regulates intercellular crosstalk in metabolic dysfunction-associated steatotic liver disease

Metabolic liver disease is highly prevalent in subjects with obesity and involves inflammation, insulin resistance, and fibrosis, leading to cirrhosis. Here, the authors show the IFNγ-IL12 axis in regulating intercellular crosstalk in the liver and playing a major role in the pathogenesis of metabolic liver disease.

• Randall H. Friedline
• Hye Lim Noh
• Jason K. Kim

Prediction model for cardiovascular disease in patients with diabetes using machine learning derived and validated in two independent Korean cohorts

• Hyunji Sang
• Sang Youl Rhee

The role of accelerometer-derived sleep traits on glycated haemoglobin and glucose levels: a Mendelian randomization study

• Rebecca C. Richmond
• Deborah A. Lawlor

News and Comment

Does Ozempic boost fertility? What the science says

Blockbuster weight-loss drugs have been linked to unexplained pregnancies. Research shows it is plausible, but more data are needed.

• Gillian Dohrn

How medical schools can prepare students for new technologies

Patient educators and nurses can demonstrate the real-life use of health technologies.

• Chantal Mathieu

Bile acid receptor protects against diabetic cardiomyopathy

Activation of the bile acid receptor TGR5 inhibits CD36-mediated fatty acid uptake in cardiomyocytes and protects against cardiac lipotoxicity and the development of diabetic cardiomyopathy in mice, according to a new study.

• Irene Fernández-Ruiz

Response to comment on “Credibility of Chat-GPT in the assessment of obesity in type 2 diabetes according to the guidelines”

• Tugba Barlas
• Alev Eroglu Altinova
• Fusun Balos Toruner

Cells destroy donated mitochondria to build blood vessels

Organelles called mitochondria are transferred to blood-vessel-forming cells by support cells. Unexpectedly, these mitochondria are degraded, kick-starting the production of new ones and boosting vessel formation.

• Chantell S. Evans

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Diabetes affects an estimated 38.4 million people in the United States and is the eighth leading cause of death.  Diabetes is characterized by the body’s inability to produce and/or respond appropriately to insulin.  These defects result in persistent elevation of blood glucose levels and other metabolic abnormalities, which in turn lead to the development of disease complications, such as heart disease and stroke, blindness, kidney failure, and lower limb amputation. In addition to increasing the risk for these complications, diabetes also doubles the risk for many forms of cancer, some forms of dementia, hearing loss, erectile dysfunction, urinary incontinence, and many other common diseases.

• Type 1 diabetes affects approximately 6 percent of adults and the majority of children and youth with diagnosed diabetes.
• Type 2 diabetes is the most common form of the disease, accounting for about 90 to 94 percent of diagnosed diabetes cases in U.S. adults. Type 2 diabetes is also increasingly being diagnosed in children and adolescents, and disproportionately affects individuals from racial and ethnic minority populations.
• Prediabetes affects an estimated 97.6 million adults in the United States. Individuals with prediabetes are at high risk of developing type 2 diabetes.
• Gestational diabetes affects a significant proportion of pregnant persons. In addition to placing the pregnant person and their child at risk for complications during childbirth, gestational diabetes increases their future risk for type 2 diabetes.

The NIDDK supports basic, clinical, and translational research to combat diabetes and its associated complications. For example, NIDDK-supported researchers are:

• studying genetic and environmental factors that contribute to the development and progression of diabetes;
• identifying ways to improve diabetes health equity and reduce diabetes health disparities ;
• studying ways to preserve insulin-producing cells of the pancreas;
• identifying new methods to improve blood glucose monitoring and insulin delivery in type 1 diabetes;
• examining behavioral approaches to prevent type 2 diabetes and to enhance diabetes self-management;
• conducting clinical trials testing new prevention and treatment strategies for diabetes and its complications; and
• uncovering the fundamental cellular and molecular pathways underlying development of diabetes and its complications to develop new and more personalized approaches to prevention and management.

The NIDDK also administers the Special Statutory Funding Program for Type 1 Diabetes Research, which is a special appropriation dedicated to supporting research on type 1 diabetes and its complications. More information on the Program and the research it supports is available on the Type 1 Diabetes Research Special Statutory Funding Program website .

In addition, NIDDK has congressional authorization for the National Diabetes Information Clearinghouse , which provides services via the NIDDK Health Information Center. NIDDK responds to questions and provides health information about diabetes to people with diabetes and to their families, health professionals, and the public.

Research Updates and News

• Bariatric surgery provides long-term blood glucose control, type 2 diabetes remission
• Celebrating the 50th Anniversary of Diabetes Research Centers
• Diabetes in America now available
• Islet Transplantation for Treating Difficult-to-Manage Type 1 Diabetes in Adults
• The Special Diabetes Program: 25 Years of Advancing Type 1 Diabetes Research

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To achieve its mission, NIDDK supports, conducts, coordinates, and plans research. NIDDK also provides data and samples from NIDDK-funded studies and explains research findings to health professionals and the public.

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Hero image credit: Reprinted from Obesity, volume 16, issue 6, Copyright 2008, with permission from Wiley-Blackwell, a publishing business of John Wiley & Sons.

Cedar-Sinai's Diabetes and Obesity Research is dedicated on uncovering the mechanisms related to diabetes, obesity and associated conditions.

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HOMA-IR: Poor Surrogate Measure of Insulin Resistance

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The respected faculty members dedicated to diabetes and obesity research at Cedars-Sinai explore a multitude of conditions and diseases through theoretical, applied and translational research.

Current Research

In the past several decades there has been an alarming increase in the prevalence of obesity and diabetes in the United States. Similar trends have now been observed throughout the Western Hemisphere, and more recently in Asia. Because the increases in obesity predate those for diabetes, we now know that obesity is a major risk factor for type 2 diabetes. In addition, increasing obesity is coupled with many other chronic ailments, including heart disease, hypertension and some cancers. At Cedars-Sinai , we have recognized the close link between diabetes and obesity by establishing a world-class research institute, the Cedars-Sinai Diabetes and Obesity Research Institute. This allows us to take an integrated approach to understanding these conditions. We have a 4-pillar approach: detection, prevention, treatment and cure.

The investigators at Cedars-Sinai are among the first to recognize the close relationship between obesity and diabetes and to uncover the underlying mechanisms that account for this hand-in-glove interaction. From our research studies, new therapies should emerge which will improve the lifestyle of the lives of patients and their families.

The Diabetes and Obesity Research labs conduct research that focuses on finding new advancements to detect, prevent, treat and cure Type 2 diabetes and obesity.

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Changing our Future Through Research

The ADA is committed to innovation and breakthrough research that will improve the lives of all people living with diabetes.

ADA Research: Science. Progress. Hope.

ADA research provides critical funding for diabetes research. With 100% of donations directed to research, our goal is to ensure adequate financial resources to support innovative scientific discovery that will translate to life-changing treatments and eventual cures.

of our funded researchers remain dedicated to careers in diabetes science

publications per grant, cited an average of 28 times, proving expertise and credibility 

Every $1 the ADA invests in diabetes research leads to $12.47 in additional research funding

ADA Research Impact

Explore some of the latest innovations and discoveries and see how the ADA continues to advance science, leverage investments and retain scientists.

Research Funds at Work

Imagine what 290 scientists, each working on a unique project at 117 institutions across the U.S. can do. Learn about the research we fund to move the diabetes fight forward.

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Uncover inspiring patient stories and find out how our research is transforming lives.

Discover programs on research, career development, training, and more.

Learn more about the current opportunities for 2024 research funding. 

Pathway to Stop Diabetes ®

A bold initiative dedicated to bringing 100 brilliant scientists to diabetes research.

Explore Research Projects

As part of our mission, ADA’s Research Programs invest in projects that have the potential to prevent the development of diabetes and help people living with diabetes. 

Type 1 Diabetes Research

Project topics span technology, islet transplantation, immunology, improving transition to self-management, and more.

Type 2 Diabetes Research

Project topics include support for potential new treatments, a better understating of genetic factors, addressing disparities, and more.

Prediabetes/Insulin Resistance Research

Projects include understanding the role of exercise, novel therapies, and more.

Gestational Diabetes Research

Projects focus on advancing the prevention of gestational diabetes and to properly diagnose and treat it when it occurs.

Research on Obesity

Projects include studying the biology of appetite regulation and metabolism, identification of new treatment targets, and trials exploring interventions for weight loss.

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Beyond Ozempic: New GLP-1 drugs promise weight loss and health benefits

The next wave of obesity drugs is coming soon.

Drug companies are racing to develop GLP-1 drugs following the blockbuster success of Novo Nordisk’s Ozempic and Wegovy and Eli Lilly’s Mounjaro and Zepbound.

Some of the experimental drugs may go beyond diabetes and weight loss, improving liver and heart function while reducing side effects such as muscle loss common to the existing medications. At the 2024 American Diabetes Association conference in Orlando, Florida, researchers are expected to present data on 27 GLP-1 drugs in development.

“We’ve heard about Ozempic and Mounjaro and so on, but now we’re seeing lots and lots of different drug candidates in the pipeline, from very early-stage preclinical all the way through late-stage clinical,” said Dr. Marlon Pragnell, ADA’s vice president of research and science. “It’s very exciting to see so much right now.”

A large portion of the data presented comes from animal studies or early-stage human trials. However, some presentations include mid-to late-stage trials, according to a list shared by the organization.

Approval by the Food and Drug Administration is likely years away for most. Some of the drugs showcased could be available for prescription in the U.S. within the next few years.

“We’ve witnessed an unprecedented acceleration in the development of GLP drugs,” said Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina. “We are now firmly entrenched in the era of the GLP.”

While the existing drugs are highly effective, new drugs that are more affordable and have fewer side effects are needed, McGowan added.

There aren’t just GLP-1 drugs in the pipeline. On Thursday, ahead of the diabetes conference, Denmark-based biotech firm Zealand Pharma released data that showed a high dose of its experimental weight loss drug petrelintide helped reduce body weight by an average of 8.6% at 16 weeks.

The weekly injectable medication is unique because it mimics the hormone amylin, which helps control blood sugar. The hope is patients will experience fewer side effects like nausea commonly associated with GLP-1 drugs such as Wegovy and Zepbound.

Can glucagon hormone help with weight loss?

GLP-1 medications work, in part, by slowing down how quickly food passes through the stomach, leading people to feel fuller longer. In several of the upcoming weight loss drugs, a different hormone called glucagon is in the spotlight. Glucagon is a key blood-sugar-regulating hormone that can mimic the effects of exercise.

One of the drugs featured at the conference on Sunday is called pemvidutide, from Maryland-based biotech firm Altimmune .

The drug contains the GLP-1 hormone, a key ingredient in Ozempic and Wegovy, in addition to glucagon.

Altimmune released data from a phase 2 trial of 391 adults with obesity or who are overweight with at least one weight-related comorbidity such as high blood pressure. Patients were randomized to either get one of three doses of pemvidutide or a placebo for 48 weeks.

Researchers found that patients who got the highest dose of the drug lost on average 15.6% of their body weight after 48 weeks, compared to the 2.2% body weight loss seen in patients who got a placebo. In similar trials, semaglutide was shown to reduce body weight by around 15% after 68 weeks.

These are not direct comparisons because the drugs weren’t compared in a head-to-head clinical trial.

Dr. Scott Harris, Altimmune’s chief medical officer, said the drug has been shown to help people lose weight, as well as provide health benefits to the liver and heart. What’s more, the drug has shown benefits in preserving lean body mass. Some studies have suggested that semaglutide, the active ingredient in Ozempic and Wegovy, can cause muscle loss.

“If people take the drugs long term, what’s going to be their long-term health? What’s going to be the long-term effects on their body composition, their muscle, their ability to function?” he said.

Harris said that people who got pemvidutide lost on average 21% of their lean body mass, which is lower than the around 25% of lean body mass people typically lose with diet and exercise.

“We’re the next wave of obesity drugs,” Altimmune President and CEO Vipin Garg said. “The first wave of mechanisms was all driven by appetite suppression. We are adding another component.”

Altimmune expects to begin a phase 3 trial soon. The company hopes the drug will be available in the U.S. sometime in 2028.

Competition could drive down costs

Expanding the number of weight loss drugs available is important for several reasons, experts say.

More options could also help alleviate the shortages seen in the U.S. with Novo Nordisk’s and Lilly’s weight loss drugs.

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Increased competition could drive down the high cost of the drugs over time. A month’s supply of Wegovy or Zepbound can cost more than $1,000, often financially untenable for many patients, experts say.

Patients can also respond differently to treatments, said Dr. Fatima Cody Stanford, an associate professor of medicine and pediatrics at Harvard Medical School. In fact, some have found the existing GLP-1 options ineffective.

“Different GLP-1 drugs may have varying levels of efficacy and potency,” she said. “Some patients may respond better to one drug over another, depending on how their body metabolizes and responds to the medication.”

Since starting Ozempic in June 2022, Danielle Griffin has not seen the results her doctor predicted. “She really expected to see a huge difference in my weight, and I just never saw it,” said the 38-year-old from Elida, New Mexico. Griffin weighed about 300 pounds and has lost only about 10 pound in two years. She said her “expectations were pretty much shattered from that.”

Amid insurance battles and shortages, she has also tried Wegovy and Mounjaro, but didn’t see a difference in her weight.

“I don’t feel like there are options, especially for myself, for someone who the medications not working for.”

The prospect of new medications on the horizon excites Griffin. “I would be willing to try it,” she said, adding that “it could be life changing, honestly, and you know that alone gives me something to look forward to.”

More drugs in the pipeline

Eli Lilly, which makes Zepbound and the diabetes version Mounjaro, has two more GLP-1 drugs in development.

On Sunday, Lilly released new data about retatrutide, an injectable drug that combines GLP-1 and glucagon , plus another hormone called GIP. GIP is thought to improve how the body breaks down sugar.

In an earlier trial, retatrutide helped people lose, on average, about 24% of their body weight, the equivalent of about 58 pounds — greater weight loss than any other drug on the market.

New findings showed the weekly medication also significantly reduced blood sugar levels in people with Type 2 diabetes.

On Saturday, there were also new findings on the experimental mazdutide, which Lilly has given permission to biotech firm Innovent Biologics to develop in China. The drug combines GLP-1 and glucagon.

In a phase 3 study of adults in China who were overweight or had obesity, researchers found that after 48 weeks, a 6-milligram dose of the drug led to an average body weight reduction of 14.4%.

The drug also led to a reduction in serum uric acid — a chemical that can build up in the bloodstream, causing health problems, and has been associated with obesity, according to Dr. Linong Ji, director of the Peking University Diabetes Center, who presented the findings.

That was “quite unique and never reported for other GLP-1-based therapies,” he said in an interview.

The drug could be approved in China in 2025, Ji said.

Improving metabolic conditions

An estimated 75% of people with obesity have nonalcoholic fatty liver disease and 34% have MASH, or metabolic dysfunction-associated steatohepatitis, according to researchers with the German drugmaker Boehringer Ingelheim. Fatty liver disease occurs when the body begins to store fat in the liver . It can progress to MASH, when fat buildup causes inflammation and scarring.

In a phase 2 trial of people who were overweight or had obesity, Boehringer Ingelheim’s survodutide, which uses both GLP-1 and glucagon, led to weight loss of 19% at 46 weeks. Another phase 2 study in people with MASH and fibrosis found that 83% of participants also showed improvement in MASH.

Survodutide “has significant potential to make a meaningful difference to people living with cardiovascular, renal and metabolic conditions,” said Dr. Waheed Jamal, Boehringer Ingelheim’s corporate vice president and head of cardiometabolic medicine.

On Friday, the company released two studies on the drug. One, in hamsters, found that weight loss was associated with improvements in insulin and cholesterol. The second, in people with Type 2 diabetes or people with obesity, found the drug helped improve blood sugar levels.  

The company is looking to begin a phase 3 trial.

CLARIFICATION (June 24, 2024, 2:31 p.m. ET): Innovent Biologics has entered into an exclusive licensed agreement with Eli Lilly for the development of mazdutide in China, not a partnership.

Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.