The Future of T1D Management: From Automated Insulin Delivery to Metabolic Controls

As we strive to cure T1D, each day unveils new insights that bring us closer to a solution. These breakthroughs not only edge us nearer to a cure but also significantly enhance the lives of those fully dependent on insulin, as well as those who are not yet. In this brief article, we will explore life-improving advancements in four key areas: Automated Insulin Delivery (AID) Systems and Metabolic Control Therapies. In a future newsletter, we will cover Complication Management Therapies, and Therapies to Alleviate the Psychosocial Burden of this disease.

Since the FDA approved the Medtronic 670G in 2016, the AID market has flourished. We are now witnessing advancements in three key areas: devices that continuously monitor both glucose and ketones, user-centric pumps that integrate CGM and AID systems, and technology providing increased automation during meals. Advancements in this space cover areas such as being able to personalize setting to tailor towards specific needs like insulin sensitivity, carb ratios and correction factors. As the algorithms driving these advancements continue to improve every day, AID system are now doing far more than just delivering insulin. An additional advantage is that AID systems are continually shrinking in size and, perhaps more importantly, becoming increasingly affordable.

In parallel to advancements in AID systems, we realize that insulin therapy is not enough to achieve optimal glycemic and metabolic control.  Even with best efforts, 70% of people living with T1D do not consistently achieve target blood-glucose control levels, and two-thirds have obesity challenges, thus remaining at risk for long-term complications. The future of T1D care is most likely multiple drugs taken safely and conveniently for glucometoblic control and long-term health. Here a few examples that are showing promise.

Vola-gidemab,  a novel drug developed by REMD is a GCGR blocker and prevents glucagon action. In T1D, poor control and too much glucagon causes blood glucose to rise. A recent 12-wk Phase 2 study found volagidemab demonstrated meaningful improvements in A1c and CGM metrics. Ultimately, this therapy may reduce the risk of DKA by decreasing ketone production. T1D Breakthrough is supporting multiple studies to understand the efficacy and safety benefits of this therapy.

Cadisegliatin (vTv Therapeutics) is developing an oral, once-daily therapy that targets the liver to improve glucose control. Similarly, in a recent 12-wk Phase 2 study, vTv lowered HbA1c with no increase in ketone levels. This therapy will begin a Phase 3 program soon.

One class of drugs that has been in the headlines recently are GLP-1 receptor agonists. Drugs like Ozempic have had blockbuster success not only in T1D but now also as anti-obesity agents. These drugs improve blood glucose by decreasing glucagon secretion, slowing gastric emptying and decreasing appetite. The challenge is that while we believe this therapy has promise for our community, so far people with T1D have not been included in industry trials.

As we continue to make strides in T1D treatment and management, the horizon looks promising with advancements poised to transform patient outcomes. These innovative therapies and technologies not only suggest a future where T1D management is more seamless and effective but also one where the diverse needs of the T1D community are addressed more comprehensively. The journey towards optimal care and potential cures is paved with each new discovery, embodying the hope and resilience of the T1D community. Looking ahead, we remain dedicated to showcasing these groundbreaking advancements and advocating for their development and accessibility. Stay tuned for our future newsletter, where we will dive into Complication Management Therapies and Therapies to Alleviate the Psychosocial Burden of T1D, further broadening the scope of life-improving innovations for those impacted by this condition.

James Pierce –

Board Member

Research Information Volunteer (RIV)