Diabetes, which is a major health challenge, is a metabolic disease characterized by a chronic rise of the glycemia (blood sugar level).

Diabetes is the result of insufficient insulin, the hormone that regulates blood sugar levels. This occurs either because its production by the pancreas is insufficient, as in the case of type 1diabetes (T1D), or because its action initially becomes less effective over time, as in type 2 diabetes (T2D).

Insulin allows glucose to enter the body’s cells and to provide them with the required energy.

Three major types of diabetes can be distinguished:

• Type 1 diabetes generally appears at a young age and represents 10% of diabetes cases. Daily insulin injections are necessary to regulate blood sugar because the pancreas does not produce enough or any insulin due to autoimmune destruction of the pancreatic cells that produce it.
• Type 2 diabetes generally appears from the age of 40 and represents 90% of diabetes cases. Insulin, whose initial production is preserved, is not effective due to insulin resistance, often linked to obesity, mainly located in the abdominal region. Blood sugar elevation can be controlled through physical activity and appropriate diet, but oral treatment and eventually insulin may often be necessary.
• Gestational diabetes occurs in pregnant women, leading to an increase in blood sugar levels that can result in complications for both the mother and the child. The rise in blood sugar disappears immediately after childbirth, but gestational diabetes poses a risk of developing actual type 2 diabetes later on.

Diabetic individuals often experience acute complications such as hypoglycemia, hyperglycemia, or ketoacidosis and may also suffer from chronic complications such as:

• Retinopathy / Blindness: diabetes is one of the most common causes of blindness.
• Cardiovascular disease: diabetes, associated with other cardiovascular risk factors such as high blood pressure, high cholesterol and smoking, is a main cause of myocardial infarctions and stokes.
• Kidney failure: diabetes is, today, the leading cause of end-stage kidney failure requiring dialysis.
• Damage to the nervous system: diabetic neuropathy affects all nerves in the body but most commonly manifests in the lower limbs, causing either pain or numbness in the extremities. This condition increases the risk of serious foot wounds. Diabetes is responsible for 8,000 cases of amputation each year.
• Infections: Diabetes can lead to skin, urinary, or pulmonary infections. Additionally, vaccination against influenza and pneumococcus should be more systematically administered.

Diabetes is a major public health challenge due to its frequency, the seriousness of its complications and the high costs that it incurs.

Researchers are constantly working to improve the quality of life of diabetic patients.

Many therapies have emerged in recent years and new revolutionary therapeutic developments could appear within 10 years.

Metformin remains the pivotal drug in the treatment of type 2 diabetes, but the availability of new drug classes and modern insulins has improved patient care.

New pathways are also moving towards the possibility of creating insulin-producing cells by genetic modification of stem cells, which could enable cell transplants to be used for the treatment of type 1 diabetes.

A new path of research focuses on the intestinal microbiota. Some gut bacteria would show « anti-diabetic » properties, which could help regulate the patient’s blood sugar control.

Progress in the development of an artificial pancreas, which will be available very soon, allow automated management of type 1 diabetes. An insulin pump, linked to a blood sugar sensor through an algorithm contained in a smartphone, adjusts the inulin delivery according to blood sugar level. An insulin pump, connected to a glucose sensor through an algorithm contained in a smartphone, adjusts the insulin delivery rate based on blood glucose levels.

Today, more than ever, researchers are focusing on all of these new pathways in order to better understand diabetes, its causes, its mechanisms and its complications. These advances will make it possible to find effective solutions and lead to innovative treatments to improve, day after day, the quality of life of diabetic patients.

Diabetes research is progressing…