From micro-pumps to the ‘Holy Grail’: What is the next breakthrough treatment for diabetics?

Pharmac began funding continuous blood monitors (CGMs) in October. Since then, about 14,500 New Zealanders with type 1 diabetes have secured one of the devices. Photo / 123RF

Technological developments have completely changed the landscape for type 1 diabetes patients in New Zealand this year. Are there further leaps in technology on the horizon?

Nearly 15,000 New Zealanders with diabetes are now able to measure their blood sugar levels almost instantly, rather than pricking their fingers multiple times a day.

Pharmac began funding continuous glucose monitors (CGMs) for type 1 diabetics in October. The wearable sensors, the size of a $2 coin, measure a person’s blood sugar levels and relay the information to a smartphone.

They can be connected to an insulin pump which automatically injects the wearer to stabilise their blood sugar (known as a hybrid closed-loop).

“It completely changes people’s lives,” said Dr Rosemary Hall, an endocrinologist at the University of Otago’s Department of Medicine.

“The week that they came in we had so many hugs and tears and emotions.”

American singer-songwriter Nick Jonas wears a CGM on his arm to manage his diabetes. He advocated for the devices during a visit to New Zealand in April 2024. Photo / Dexcom

It is the most significant development in treatment since the arrival of insulin 100 years ago. And in a fast-developing sector, further changes could be on the horizon.

The Herald spoke to a couple of experts about advances in this field, from products which are on shelves now, to the “Holy Grail”.

Patch pumps

CGMs have made lives easier but the pump and catheter can be bulky or difficult to wear, especially for active people or parents of young children.

“I’ve got quite a few patients who are farmers, for example, and it’s really hard to pick up a sheep if you’re going to be dislodging your pump in the process,” said Hall.

“Those kind of areas of work or lifestyle mean that you want to just have a smaller item and no tubing.”

Patients can now get patch pumps, or micro-pumps, which remove the need for tubing.

The small plastic pumps stick on the skin and have a filament which feeds the insulin into the body. They do this by communicating wirelessly with a CGM.

The pumps are available now but are expensive and are not funded by Pharmac.

Products available in New Zealand sell for about $450 for 10 disposable pumps, which each last two to three days.

Faster insulin

In non-diabetics, insulin is released straight into the bloodstream after eating, and takes action immediately to prevent blood sugar levels from rising.

But when diabetics inject insulin into their fat - such as through a pump - it can take at least 15 to 30 minutes to work.

“Ultra-fast” insulins are now being trialled, with the more promising products taking effect within 10 to 12 minutes. They are also slightly faster to have their full effect.

“They are still nowhere near as clever as what the body does,” said Dr Ben Wheeler, paediatrician endocrinologist and diabetes researcher at the University of Otago.

But trials were gradually showing incremental improvements, and there is hope that one day an insulin will be developed that works nearly as quickly as a healthy pancreas.

Immune modulation

There is strong evidence that problems with a person’s immunity could lead to diabetes by causing cells to fail in the pancreas.

Some clinical trials are looking at whether altering the immune system could delay or even halt the onset of diabetes, especially among people who are at high risk or in the very early stages of the disease.

Known as immune modulation, the treatments involve transplanting micro-organisms or other substances into a patient.

In one of the more high-profile experiments, a small amount of faecal matter is transferred from a patient with a healthy colon to another with a diseased colon.

In one randomised controlled trial, 35 patients received immune modulation treatment while another 46 people received a placebo. After two years, those who received the treatment had a 59 per cent improvement in insulin production.

“So it slows things down but there is no miracle here yet,” said Wheeler.

Smart insulin

Smart insulin is considered the “Holy Grail” and the closest thing to a possible cure for Type 1 diabetes.

It involves injecting a novel insulin into the body, possibly once a week, which lies dormant when blood sugar levels are normal. It can then automatically “switch on”, depending on glucose levels in the blood.

Smart insulin has only been trialled in animals so far but human trials are scheduled for next year.

“Once-a-week injections are very, very appealing because many people at the moment who are not on a pump are injecting at least five times a day, often more than that,” said Hall.

She said trials would have to ensure the safety of the substance. It involved injecting a large amount of insulin at one time, and researchers would have to show that it did not release too much insulin too quickly.

Wheeler said smart insulin was the “Holy Grail” and if a safe, effective product was ever created it would effectively make CGMs and other technology redundant.

“There are hundreds of decisions every day that people with diabetes make. And an insulin that you could inject once a day or once a week that did all that for you - that would be revolutionary.

“That caveat is that we are nowhere near that point.”

Wheeler said the most promising advances in the next few years are likely to be incremental improvements to technology that already exists, like CGMs.

He said companies and researchers were attempting to gradually “close the loop” between CGMs and their pumps, meaning that less and less human interaction was required.

If that work was successful, patients would gradually be able to input fewer details into their device. Or one day, simply tell their device that they are about to start eating.