What Every Healthcare Worker Needs to Know About Diabetes in 2024

Diabetes care is facing a reality check. With 38 million people in the U.S. living with the condition, and nearly a quarter of them unaware until complications arise, the burden on our healthcare system is impossible to ignore. If we continue to approach diabetes the way we have in the past, we’ll never catch up. But things are changing. Focus is expanding beyond just glucose control. Today, real progress lies in addressing the bigger picture: how we manage obesity, leverage new technology, ease the burden on both patients and providers, and make headway toward an actual cure. In this breakdown, we’ll cover the four key areas every healthcare professional needs to understand to keep pace with the latest advancements. Whether it’s the evolution of GLP-1 treatments or the game-changing potential of tech innovations like continuous
glucose monitoring, this is your comprehensive update on diabetes care in 2024.

Why Managing Glucose Alone Isn’t Enough
For a long time, managing diabetes was focused solely on glucose. If patients could keep their blood sugar levels close to normal, we believed that was enough. But today, we understand that diabetes is much more complex than a number on a glucose meter. Limiting our focus to just blood sugar control isn’t enough anymore, it’s time to shift our perspective.

The new standard in diabetes care looks at three key factors that should guide treatment:

1. Comorbidities
Diabetes rarely comes alone. It often walks hand-in-hand with other serious conditions like cardiovascular disease, kidney disease, or heart failure. In fact, cardiovascular disease remains the leading cause of death for people with diabetes, and kidney failure is a common complication. These comorbidities now play a central role in how we choose treatments. For example, if a patient has atherosclerotic cardiovascular disease, GLP-1 receptor agonists are recommended regardless of their glucose levels or whether they’re on metformin. Similarly, for patients with heart failure or chronic kidney disease, SGLT2 inhibitors are often the first line of therapy. The focus is shifting from a "one size fits all" model to a more personalized approach based on individual patient risks.

2. Weight Management
Obesity is a major driver of type 2 diabetes, and treating it can transform diabetes outcomes. For years, weight loss medications gave us modest results. If a patient lost 5-7% of their body weight, that was considered a success. But the new generation of GLP-1 receptor agonists (eg: Semaglutide) is changing the game, delivering weight loss of up to 15-22%. These drugs are proving that significant weight reduction can be
achieved, which not only improves blood sugar levels but also reduces the risk of many obesity-related complications. Ignoring weight management in diabetes care today would mean missing a huge piece of the puzzle.

3. Efficacy of Treatment options
Not all diabetes medications are created equal. Some drugs are far more effective than others at lowering glucose levels. So, when choosing a treatment plan, clinicians must now weigh the efficacy of a drug in terms of how far a patient’s glucose levels are from their target range. The right choice might be a single powerful agent or a combination of therapies that can tackle both glucose control and weight management. As the range of options grows, the decision-making process has to be more nuanced, considering what will get the patient to their goal most effectively. More and more, physicians are shifting their approach, moving from simply managing symptoms to addressing the whole patient. But what does that actually look like in practice?

Four areas stand out as critical to making this shift: obesity management, the role of technology, the burden on both patients and providers, and our progress toward a cure.

Let’s dive into each of these areas to explore how they’re shaping the future of diabetes care.

1. Managing Obesity - Why is Ozempic So Popular?
For decades, weight management was seen as a secondary concern in diabetes care, something nice to tackle but not essential. That has changed dramatically. Obesity is now recognized as one of the primary drivers of type 2 diabetes, and addressing it is at the core of the new treatment paradigm.

With the advent of GLP-1 receptor agonists and similar therapies, we’ve entered a new era in weight management. These medications, such as semaglutide and tirzepatide, are providing unprecedented results and delivering weight loss up to 22% in some patients. That’s miles ahead of previous therapies, which typically resulted in a modest 5-7% weight loss.

This shift is significant because it directly addresses the root cause of many patients’ struggles with diabetes. By treating obesity, we’re not just improving glucose control—we’re also reducing the risk of complications like cardiovascular disease, sleep apnea, and even some cancers.

New studies continue to emerge, showing the potential of these treatments to impact other comorbidities linked to obesity, such as kidney disease and heart failure. The promise of these agents extends beyond just diabetes management, suggesting they may reshape the treatment of obesity-related conditions as a whole.

However, as promising as these treatments are, they’re not without their challenges. First, access remains a significant issue. These medications are expensive, and many patients, particularly those from underserved communities, struggle to afford them. This raises concerns about widening disparities in diabetes care, where those with access to the latest treatments see better outcomes, while others fall further behind.

Additionally, GLP-1 receptor agonists come with side effects, particularly gastrointestinal ones. Nausea, vomiting, and diarrhea are common, especially when starting or increasing doses. For some patients, these side effects can be severe enough to stop treatment altogether. In fact, adherence to these therapies isn’t as high as we’d like. About 40-50% of patients stop using them after one year, largely due to cost or side effects.

That said, these issues are not necessarily deal-breakers. The side effects can be managed with careful dosing and patient education, gradually increasing the dosage to help the body adjust. And with competition growing in the pharmaceutical space, we can hope to see costs come down, making these life-changing treatments more accessible.

2. Advances in Diabetes Technology in 2024
Technology is becoming more important in managing diabetes.

Continuous Glucose Monitors
In the past decade, advancements in tech, particularly continuous glucose monitors (CGMs), have revolutionized the way diabetes is managed, both for patients and healthcare providers. They allow for real-time tracking of blood glucose levels and transmit that data to a smartphone or 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 providers, the data from CGMs offer a comprehensive view of a patient’s glucose trends, making it easier to personalize treatment plans.

Integrating Insulin Pumps with Continuous Glucose Monitors
Additionally, 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. While 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
Digital platforms are emerging that use behavioral phenotyping, analyzing data to tailor treatment to individual patient behaviors. These platforms take into account not just glucose data, but also factors like activity levels, food intake, and even psychological patterns to create a more holistic and personalized approach to diabetes management.

3. Burden of Diabetes for Patients and Providers
But with all this progress comes a significant issue – burnout for patients and providers. The daily grind of monitoring blood sugar, adjusting medications, and managing complications is mentally and physically exhausting.

The Patient’s Burden
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 when dealing with the long-term nature of the disease and the fear of complications like blindness or 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 requires careful thought and planning.

The Provider’s Burden
Healthcare providers, 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 burden 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 providers struggling to balance patient care with their own well-being.

Addressing the Burnout Crisis
While there is no quick fix, several strategies are emerging to help ease this burden for both patients and providers. 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. Yet, despite strong evidence supporting their effectiveness, these programs are vastly underutilized—only 10-20% of people with diabetes ever receive this kind of support. Second, healthcare systems are beginning to experiment with team-based care models, where 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 AI and machine learning to sift through patient data and provide actionable insights is another key strategy to reduce the burden on providers. 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 providers.

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

4. 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 five-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.

The Supply Problem Solved?
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 two 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 like fibrosis (where scar tissue forms around the capsules) and ensuring enough 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 show promise, but this approach is still in its infancy.

Where Are We Now?
While 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. While 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.

While a true "cure" for type 2 may be further off, the advances in GLP-1 and 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.

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