Diabetes affects the everyday lives of more than 100 million people living in the US.
Diabetes is a complex disease that affects the body’s ability to produce or respond to insulin, a hormone that helps regulate blood sugar.
“One of the most exciting areas where I think we’ll see diabetes research and treatment expanding is to the microbiome.”
New scientific advances are making the chronic condition easier to treat. New insights into how exactly the disease works could also offer different ways to treat it.
We asked 2 Cedars-Sinai diabetes experts for predictions on where the field will go next and reflections on their own diabetes research. Richard Bergman, PhD is the director of the Diabetes and Obesity Research Institute. Dr. Ruchi Mathur is an endocrinologist and director of the Diabetes Outpatient Teaching Education Center.
Important diabetes developments
Bariatric surgery balances blood sugar levels
Bergman: We’ve found that bariatric surgery can normalize the blood sugar level in type 2 diabetes. There’s no other therapy that can normalize the blood sugar. It’s a mystery why that works, but it does.
Obviously, we’re not going to perform weight loss surgery on all the people who have type 2 diabetes. But if we could figure out why this kind of surgery normalizes blood sugar levels, we might be able to find an alternative therapy that can do the same thing.
Better tech for diabetes treatment
Dr. Mathur: The technology for insulin pumps, computerized devices some diabetes patients use to manage their blood sugar, is really becoming refined.
Some of the new pumps now have the ability to shut off when blood sugars go too low. Sensors are getting better, too: They are taking accurate readings of blood sugar levels and letting patients know when they need to take action.
We’re getting closer to the ultimate goal—a smart pump that is linked to the sensor and automated. What we call a “closed loop” system.
On the horizon
Many types of diabetes
Bergman: It’s becoming more and more clear that type 2 diabetes isn’t just one disease.
There are different causes. Once we’re able to determine the different types and what causes them, we’ll be able to take a precision medicine approach and offer individualized therapies. That’s one way the field is evolving.
We’re also getting better at detecting diabetes before it happens and identifying the people who are at risk. That would allow us to work with patients on interventions that could potentially prevent or delay developing diabetes.
Dr. Mathur: One of the most exciting areas where I think we’ll see diabetes research and treatment expanding is to the microbiome.
The way we look at diabetes is going to change in the future—and so is our classification of diabetes. Instead of just types 1 and 2, I think we are going to define diabetes more by causes and responses. I think our understanding of the microbiome—all the bacteria, fungi, and other microorganisms that live in our bodies—is going to play a major role in some of these definitions.
In the lab, we’re looking at the way different microbes in the gut can influence metabolism, and the role they play in inflammation, harvesting energy, calorie consumption, and more.
The liver connection
Role of the liver in diabetes
Bergman: We’re very interested in a cause of diabetes that hasn’t been previously appreciated.
Diabetes is a systemic disease, meaning that many organs are involved: the liver, the pancreas, the muscles, the kidneys, the brain.
We’ve published some really interesting research that shows one of the possible causes of diabetes is the rate of insulin clearance, that is, how quickly the liver removes insulin from the body.
That study focused on African-Americans, who are affected by diabetes at much higher rates than non-Latino white people. We looked at adults and children, and the data clearly suggested the trouble with insulin clearance is likely genetic. We’re very interested in further exploring the connection between insulin clearance diabetes.