The future of diabetes treatment: Is a cure possible?

Diabetes has become an epidemic, affecting over 589 million people worldwide to lifelong medication. Diabetes is the major cause of blindness, kidney failure, heart attack, and stroke. It is estimated that the number of people affected by diabetes will rise to 853 million by 2050. Biotech is striving to find a diabetes treatment that can cure this chronic disease, but how close are we?

Despite its huge impact on the global population, there is still no cure for any type of diabetes. Most treatments help patients manage the symptoms to a certain extent, but diabetics still face multiple long-term health complications.

Diabetes affects the regulation of insulin, a hormone required for glucose uptake in cells, resulting in high levels of blood sugar. While there are some similarities in symptoms, the two main types of diabetes develop in different ways.

Type 1 diabetes is an autoimmune disease that destroys insulin-producing beta-pancreatic cells. In contrast, patients with type 2 diabetes develop insulin resistance, meaning that insulin is less and less effective at reducing blood sugar. 

Although only type 1 and type 2 diabetes are formally recognized by organizations like the World Health Organization (WHO), researchers have proposed additional subtypes to better capture the diversity of diabetes cases. For example, type 3c diabetes refers to cases caused by pancreatic damage, while type 3 has been used, though controversially, to describe Alzheimer’s disease linked to insulin resistance in the brain. Type 4 and type 5 have emerged more recently in scientific literature and media to describe, respectively, age-related diabetes in lean individuals and malnutrition-related diabetes in young people. These terms are not officially recognized but illustrate efforts to better understand atypical forms of the disease.

Let’s have a look at what’s brewing in the field and how it will change the way diabetes is treated.

Type 1 diabetes treatments

The battle to cure diabetes takes us back to 1921 and the discovery of insulin. Since then, we have learned a lot about the disease, and biotech companies have tried multiple approaches, some more successful than others.  

A brief history of type 1 diabetes

Managing the disease with an artificial pancreas

The management of type 1 diabetes has evolved significantly, moving beyond traditional insulin injections toward more automated and precise delivery methods.

Modern insulin pumps provide continuous subcutaneous insulin infusion, offering more stable glucose control than multiple daily injections. Recent innovations include patch pumps and tubeless systems, improving patient convenience and discretion.

One of the most transformative advancements has been the development of hybrid closed-loop systems, often referred to as early forms of an artificial pancreas. These systems integrate continuous glucose monitoring (CGM), insulin pumps, and advanced algorithms to automatically adjust insulin delivery in real time, aiming to maintain glucose levels within a target range and reduce the burden of constant manual monitoring.

Notable examples include Medtronic’s MiniMed 670G, approved by the FDA in 2016. It was the first hybrid closed-loop system, automatically adjusting basal insulin delivery based on CGM readings. Tandem t:slim X2 with Control-IQ incorporates predictive algorithms to fine-tune insulin delivery and improve time-in-range outcomes.

Research is also progressing toward smart insulin, glucose-responsive insulin formulations that activate only when blood sugar levels rise. Early studies in animal models have shown promise, with hopes of reducing hypoglycemia risk and simplifying insulin therapy if these approaches translate successfully into human treatments.

Attacking the origin with immunotherapy

Because type 1 diabetes is an autoimmune condition, one of the most promising research directions is to stop, or at least slow down, the immune system’s attack on insulin-producing beta cells. A growing number of therapies are being tested to delay disease onset or preserve remaining beta-cell function, especially in the early stages of the disease.

In 2022, the FDA approved teplizumab (Tzield), making it the first treatment specifically designed to delay the onset of clinical type 1 diabetes. The drug is an anti-CD3 monoclonal antibody that helps modify the activity of T cells involved in the autoimmune attack. In clinical study, people at high risk of developing diabetes who received teplizumab stayed diabetes-free for a median of two years longer than those who didn’t.

Another approach under investigation involves introducing beta-cell antigens — proteins normally found on insulin-producing cells — in controlled ways to “teach” the immune system not to attack them. In one early-stage trial, researchers used a mix of six beta-cell peptides in recently diagnosed patients and observed signs of restored immune regulation.

Some labs are also working with modified immune cells, such as tolerogenic dendritic cells, to help retrain the immune system. These engineered cells promote regulatory T cells, which can suppress the autoimmune attack. The concept is still early, but initial clinical trials suggest this kind of cellular therapy is safe and worth exploring further.

Beyond targeted immunotherapies, researchers are also repurposing broader immune-modulating drugs. Baricitinib, a JAK inhibitor used in rheumatoid arthritis, has shown encouraging results in people recently diagnosed with type 1 diabetes. Those receiving the drug required less insulin and maintained better beta-cell function than untreated patients.

Replacing missing cells with cell therapy

Efforts to restore insulin production in type 1 diabetes have increasingly focused on regenerative approaches, particularly stem cell–based therapies. The aim is to replace the destroyed pancreatic beta cells or protect them from being damaged.​

In 2024, cell therapy recorded one of the biggest wins against the disease. A case in China demonstrated that a 25-year-old woman with type 1 diabetes achieved insulin independence after receiving a transplant of islet-like cells derived from her own reprogrammed stem cells. The cells were implanted into her abdominal muscles, and within three months, she no longer required insulin injections. This outcome suggests the potential of autologous stem cell therapies to restore endogenous insulin production without the need for immunosuppression.

While this success is significant, using a person’s own cells is hard to scale and commercialize. In response, Vertex Pharmaceuticals has been developing VX-880, a therapy involving fully differentiated islet cells derived from human embryonic stem cells. In trials, some participants achieved insulin independence after receiving the treatment, which involves infusing the cells into the hepatic portal vein. While promising, this approach currently requires immunosuppressive therapy to prevent rejection.

To circumvent the need for immunosuppression, researchers are exploring encapsulation devices that protect transplanted islet cells from immune attack while allowing glucose and insulin to pass through. For instance, ViaCyte’s PEC-Encap device contains pancreatic progenitor cells within a semi-permeable membrane. Early trials have shown that some patients experienced improved glucose control without the need for systemic immunosuppression.

And, as research pushes, regulatory approvals are starting to follow. In 2023, the FDA approved donislecel (Lantidra), the first allogeneic pancreatic islet cell therapy for adults with type 1 diabetes experiencing severe hypoglycemia. Derived from deceased donor pancreases, the therapy involves infusing islet cells into the liver. In clinical studies, a significant proportion of recipients achieved insulin independence for varying durations.

Using gene editing to overcome cell therapy’s challenges

One of the main challenges in cell therapy is that newly implanted insulin-producing cells are usually recognized and destroyed by the immune system, the same mechanism that caused the disease in the first place. Researchers are now using gene editing to help these cells go unnoticed.

For instance, CRISPR Therapeutics and Vertex Pharmaceuticals initially collaborated on VCTX210A, a gene-edited, allogeneic, stem cell-derived therapy for type 1 diabetes. However, in early 2024, Vertex decided to terminate this collaboration. Consequently, CRISPR Therapeutics assumed full ownership of the program and rebranded it as CTX-211. This new candidate incorporates additional gene edits aimed at enhancing cell fitness and immune evasion. A phase 1 trial for CTX-211 is currently ongoing. 

Separately, Vertex continues to pursue its own type 1 diabetes therapies, such as VX-880 and VX-264.

Type 2 diabetes treatments

Type 2 diabetes accounts for the vast majority of diabetes cases worldwide and is driven primarily by insulin resistance and progressive beta-cell dysfunction. While lifestyle changes remain the cornerstone of prevention and early management, biopharma options have expanded significantly over the past few decades.

A brief history of type 2 diabetes

Stimulating insulin production

One of the biggest shifts in type 2 diabetes treatment has been the emergence of glucagon-like peptide 1 (GLP-1) receptor agonists, which stimulate insulin production in pancreatic beta cells and suppress glucagon secretion. 

Initially developed to manage blood glucose, GLP-1 agonists gained massive traction in 2023 when studies highlighted their benefits in people with obesity and heart conditions. In one U.S. trial involving 529 people treated with semaglutide for diabetes and Wegovy (semaglutide) for obesity, participants showed double the heart improvement after one year of treatment. Another large-scale study of 17,000 people found that those taking semaglutide were 20% less likely to suffer heart attacks and strokes.

A newer generation of combination therapies is pushing these benefits even further. Tirzepatide (Mounjaro), approved in 2022, merges the actions of GLP-1 and gastric inhibitory polypeptide (GIP) in a single molecule. This dual action helps lower glucose levels, reduce appetite, and trigger fat loss. It was also approved in 2023 under the name Zepbound for weight management in people without diabetes.

Even more ambitious candidates are in development. Researchers are now testing triple agonists that combine GLP-1, GIP, and glucagon receptor activity to further enhance weight loss by increasing energy expenditure.

Drug delivery is also evolving. While GLP-1s have traditionally required injections, oral formulations are on the horizon. Orforglipron, an oral GLP-1 receptor agonist from Eli Lilly, showed promising phase 3 results in 2025 and could soon offer a needle-free option for patients, helping improve long-term adherence.

Pricing remains a barrier, with treatments like semaglutide still costing around $1,000 per month in many markets. Broader access will likely depend on policy shifts and future generic versions.

Targeting the microbiome

In the past decade, scientists have realized the big role that the microbes living inside and on us play in our health. The human microbiome, and especially the gut microbiome, has been linked to multiple chronic diseases, including diabetes.

Recent studies have explored interventions aimed at modulating the gut microbiota to improve glycemic control. For instance, fecal microbiota transplantation (FMT) has been investigated as a means to restore microbial balance. A 2024 review from Nature highlighted that while FMT can alter gut microbiota composition, its long-term efficacy in improving insulin sensitivity in type 2 diabetes patients remains uncertain, underscoring the need for further research into standardized protocols and donor selection.

Pendulum Therapeutics has developed ‘Pendulum Glucose Control,’ a medical probiotic containing strains like Akkermansia muciniphila and Clostridium butyricum. Clinical studies have demonstrated that this formulation can reduce hemoglobin A1c levels by 0.6% and decrease postprandial glucose spikes by 33% in individuals with type 2 diabetes. 

More recently, Valbiotis’ TOTUM-63, a plant-based polyphenol-rich extract, has shown promise in managing early-stage type 2 diabetes. The phase 2/3 clinical study, presented at the 2024 European Association for the Study of Diabetes (EASD) congress, demonstrated that TOTUM-63 significantly reduced glycated hemoglobin levels in prediabetic and early type 2 diabetes patients.

While these advancements are encouraging, the complexity of the gut microbiome and its interactions with host metabolism necessitate further investigation. Establishing causality and understanding the mechanisms underlying these interventions will be crucial for integrating microbiome-targeted therapies into standard type 2 diabetes management protocols.

What’s next in diabetes treatment?

In type 1 diabetes, cell therapy has already begun to show life-changing potential. But new efforts are focused on making these therapies scalable and accessible, including developing gene-edited insulin-producing cells that can evade immune attack and devices that protect them from rejection without immunosuppression. Immune-modulating strategies that delay or prevent the onset of type 1 diabetes are also gaining traction, shifting the goal from treatment to prevention.

In type 2 diabetes, the next wave may be defined not by a single drug, but by the convergence of technologies. Smart insulins, nanotechnology-enabled oral delivery, and non-invasive glucose monitoring tools are in development to reduce treatment burden. Researchers are also looking at early intervention strategies, including gut-targeted procedures, microbiome modulation, and metabolic reprogramming, to tackle the disease before it progresses.

Across both types, artificial intelligence is increasingly being used to personalize treatment plans, monitor risk in real time, and optimize dosing. And as the understanding of diabetes deepens, the distinction between metabolic, immune, and endocrine pathways is becoming less rigid.

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