Photo Credit: Alena Butusava

In Part 1 of this series, we explored how diabetes care is evolving beyond glucose management alone and examined the first of 4 critical areas reshaping diabetes treatment: obesity management through glucagon-like peptide 1 (GLP-1) agonists and other innovative therapies. Now, we’ll dive into the remaining 3 areas that are transforming the landscape of diabetes care: the role of technology in treatment, the growing burden on both patients and clinicians, and the promising progress toward a potential cure. These developments are not just changing how we treat diabetes today—they’re laying the groundwork for revolutionary advances in patient care.

Continuous Glucose Monitors

In the past decade, advancements in technology, particularly continuous glucose monitors (CGMs), have revolutionized the way diabetes is managed, both for patients and healthcare professionals. They allow for real-time tracking of blood glucose levels and transmit the data to a smartphone or other electronic device. This constant stream of information helps patients keep their glucose levels within target ranges, reducing the frequency of dangerous highs and lows. But perhaps most importantly, these devices remove the need for frequent finger sticks—a huge quality-of-life improvement for people living with diabetes. For healthcare professionals, the data from CGMs offer a comprehensive view of a patient’s glucose trends, making it easier to personalize treatment plans.

In addition, some insulin pumps are now paired with CGMs to create automated insulin delivery systems. These “closed-loop” systems act like an artificial pancreas, adjusting insulin delivery in real time based on CGM data. Although this technology isn’t yet perfect, it represents a major leap forward in helping patients better manage their condition with less manual intervention.

Digital health platforms that use behavioral phenotyping are emerging; they analyze data to tailor treatment to individual patient behaviors. These platforms take into account not just glucose data but also factors such as activity levels, food intake, and even psychologic patterns to create a more holistic and personalized approach to diabetes management.

Burden of Diabetes for Patients and Clinicians

With all this progress comes a significant issue—burnout for patients and clinicians. The daily grind of monitoring blood glucose levels, adjusting medications, and managing complications is mentally and physically exhausting.

For individuals with diabetes, every day requires vigilance. From meal planning and blood glucose monitoring to exercise and medication adherence, it can feel like there’s no escape from the demands of the condition. On top of that, diabetes is often associated with mental health challenges such as anxiety, stress, and depression, particularly in dealing with the long-term nature of the disease and the fear of complications including blindness and amputation.

One of the biggest burdens for patients is the constant need to make decisions about their care. Every meal, every exercise routine, and every dose of insulin require careful thought and planning.

Healthcare professionals, particularly those on the front lines, face a daunting workload when it comes to diabetes care. With millions of patients requiring ongoing monitoring and treatment adjustments, the capacity of the healthcare system is stretched thin. Many clinics are already overburdened, and as diabetes rates continue to climb, the situation will only become more strained.

A recent survey showed that more than half of healthcare professionals involved in diabetes care report feeling burned out, with many citing the administrative burdens of managing patient data and keeping up with the latest treatment guidelines. The time required to manage each patient’s individual needs, especially with the influx of data from digital health tools, leaves many clinicians struggling to balance patient care with their own well-being.

Addressing the Burnout Crisis

Although there is no quick fix, several strategies are emerging to help ease this burden for both patients and clinicians. First, there’s an increasing emphasis on empowering patients to take a more active role in managing their condition. Diabetes self-management education programs have shown promise, helping patients learn the skills they need to navigate their condition with greater independence. Despite strong evidence supporting their effectiveness, these programs are vastly underutilized: only 10% to 20% of people with diabetes ever receive this kind of support. Second, healthcare systems are beginning to experiment with team-based care models in which care is shared among a broader range of healthcare professionals, including nurse practitioners, dietitians, and diabetes educators. By delegating certain aspects of care, these models help spread the workload and allow physicians to focus on more complex cases. Third, leveraging artificial intelligence and machine learning to sift through patient data and provide actionable insights is another key strategy to reduce the burden on clinicians. This technology has the potential to highlight the most critical issues, prioritize patients who need immediate attention, and reduce the mental load on overworked healthcare teams. However, the implementation of these tools requires careful integration into clinical workflows to ensure that they alleviate rather than add to the pressure on clinicians.

However, nothing would ease the burden of diabetes care like a cure.

The Path Toward a Cure

If there’s one thing patients with diabetes consistently ask for, it’s a cure. And yet, despite decades of research and significant advances, the reality of a cure has remained elusive. Promises of a 5-year cure timeline have come and gone, leaving many patients disillusioned. But there is reason for cautious optimism. Recent breakthroughs in stem cell research, gene editing, and immune system modulation are bringing us closer than ever before to what could be a long-term solution, especially for type 1 diabetes.

Let’s break down where we stand today.

One of the most promising areas of research is the development of stem cell–derived islet cells. For years, researchers have been able to isolate islet cells from deceased donors and transplant them into people with type 1 diabetes. However, the supply has always been limited; there simply aren’t enough donor pancreases to go around. But stem cell technology can help.

Scientists have now developed a process to take blood cells from a patient, reprogram them into stem cells, and grow them into insulin-producing islet cells. This technology promises to provide an unlimited supply of islet cells for transplantation. In recent trials, some patients have been able to stop taking insulin altogether for extended periods after receiving these transplants. It’s proof of concept that the basic idea works.

Protecting the New Cells

Of course, transplanting new islet cells doesn’t solve the root problem of type 1 diabetes: the autoimmune attack that destroys them in the first place. To address this, researchers are exploring 2 main strategies. The first involves protecting the transplanted cells in tiny, bioengineered capsules that shield them from the immune system’s attack. These microcapsules are designed to allow nutrients and oxygen to flow in while keeping immune cells out. However, challenges such as fibrosis (when scar tissue forms around the capsules) and ensuring an adequate oxygen supply to the cells remain major hurdles. The second strategy is to modify the islet cells themselves using CRISPR gene-editing technology. By altering the surface proteins of these cells, scientists are working to make them “invisible” to the immune system, preventing the autoimmune attack altogether. Early trials have shown promise, but this approach is still in its infancy.

Although there’s no immediate cure on the horizon, the research happening now is more advanced than ever before. For the first time, we have the tools to not only produce an unlimited supply of islet cells but also protect them from the body’s immune system. The next few years will be critical as these therapies move from small trials to larger-scale studies, but there’s real hope that a functional cure could be within reach.

For patients with type 2 diabetes, the situation is a bit different. Although type 1 diabetes requires a direct solution to the autoimmune attack on islet cells, many people with type 2 diabetes still produce some insulin. The focus here is more on improving insulin sensitivity and reducing the burden of obesity-related complications.

Although a true “cure” for type 2 may be further off, the advances in GLP-1 and sodium-glucose cotransporter-2 (SGLT2) therapies are offering better control and potentially long-term remission for some patients.

Looking Ahead

The road to a cure is complex, but the progress being made is undeniable. Stem cell research, gene editing, and advancements in immunology are bringing us closer than ever before to breakthroughs that could change the landscape of diabetes care.

Although we can’t say for certain when a cure will arrive, healthcare professionals must stay informed about these developments, as they will undoubtedly reshape how we approach diabetes care in the future.

Robert Gabbay, MD, PhD, has disclosed no relevant financial relationships. 

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.