as seen in the Voice newspaper November 9th 2024

Diabetes well- being is closely connected to social determinants of health. Both the external conditions where people live and work, and the internal aspects such as coping skills and self care, play important roles in outcomes. Individuals, families, and society as a whole face various chronic stressors that can feel like “small fires” to be put out. These are days in which negativity may seem to win rather than optimism.

Changes in access to, and cost of medications at local pharmacies, safe neighborhoods free from noise, smoke and music late at night, and safe spaces for physical activity are all essential. Additionally, higher food prices, and other financial challenges can negatively affect persistence with medication, physical activity, sleep quality, and meal plan success. However, adequate social and family support are the basis of intervention.

There have been updates in diabetes care. Semaglutide, a once weekly medication, promotes weight loss in individuals with type 2 diabetes. The predicted weight loss of10-15% has fallen short in the real -world outcomes. However, the positive focus remains on improved cardiometabolic parameters with a5-7% weight loss. In SUSTAIN trials, semaglutide was associated with reduced adverse heart events compared to a placebo, along with improved blood glucose control and a 4-5% reduction in body weight over 30 weeks. Other benefits include pain reduction and improved physical functioning. However there have been some reports of adverse effects including nausea, vomiting, diarrhoea, constipation and other gastrointestinal issues. These effects have led to hospitalisations, particularly with compounded pharmacy medications. With proper physician support, these side effects can often be managed successfully.

There are several promising areas of research that offer potential, reducing the need for medication or providing other solutions for diabetes care. Continuous glucose monitoring without a prescription has become more accessible, although cost remains a barrier.  This technology allows individuals to track time in range data more easily, and provides motivation to observe how meals, physical activity, and sleep influence blood glucose levels. The sensor lasts about two weeks and reduces the need for finger sticks.

The search for a diabetes cure continues, with research into stem cells and mesenchymal/ stromal cells, which may reduce peripheral insulin resistance, protect and regenerate beta cells that producing insulin. Islet cell transplantation has also been almost curative but requires immunosuppressant medications.

In one notable case, reprogrammed stem cells reportedly cured a 25 year old woman of type1 diabetes within three months (as reported in Nature, September 26th2024). At Harvard Stem Cell Institute (HSCI), researchers have reprogrammed adult and embryonic cells into insulin producing beta cells, although immunosuppressive treatment is still needed. Genetic manipulation is another promising area of research.

People with diabetes are closer to management solutions today than in previous decades. You may not always receive recognition for your hard work managing blood glucose through persistence, prioritisation, and even finding joy. Despite fatigue and other challenges, you continue to move forward, showing resilience and optimism. You are a champion in your own right.