On February 24, 2024, at the San Raffaele Diabetes Research Institute (DRI), there was talk about flying pigs and the Moon mission. It reminded me of the year 2021, my questions, and the emails I sent – whether it was possible to create “personalized insulin” for my daughter, whether some of her beta cells could be saved for the future, or if there were ways to modulate her immune system. At times, with the responses from some doctors, I felt like I was in the 1960s, aiming to reach the Moon. Today, I know that my questions were not folly or the desperate plea of a mother.

The 6th edition of the “DRItti a voi” (Directly to You) conference took place in Milan. After five years, the halls of the Vita-Salute San Raffaele University were once again filled with hundreds of participants, mostly individuals with diabetes and their loved ones. Dozens of researchers and doctors were available to answer all their questions. The main blocks were moderated by Giulia Mengolini, a journalist and blogger, and co-host of the Italian podcast “I Funamboli.” The host of the event was none other than the director of the research center, Prof. Piemonti, with attention to every detail. The event was divided into three parts.

“What’s Hot and What’s New – at the Borders of DRI”

The first block connected the audience with the wider world. It was opened by Monia Elhajjaoui, the winner of the “This is Diabetes Photo and Art Competition” 2023, sponsored by Ascensia Diabetes Care. Through her creation “The search for balance,” she described what diabetes means to her. Besides type 1 diabetes, she also lives with celiac disease and hypothyroidism. After diagnosis, which was not particularly traumatic, she describes how her life with deasase evolved over time and the phases she went through. From initially trivializing, through denial during adolescence, to the current phase of acceptance. Although, as she doesn’t fail to mention, “I find it hard to believe that a chronic illness can be accepted.” Where I found myself in her speech, besides the initial phase, is what helps Monia the most in tougher times – rational optimism… An innovative project, Citizen Science, in collaboration with Diabete Italia, was introduced further. It offers an extraordinary opportunity to actively participate in scientific research in the field of type 1 diabetes.

Listening to the conversation of two giants in the field, such as Piemonti and Melton, was an additional reason why it was worth coming to Milan. Doug Melton, a world-class scientist. But how did he get involved in finding a cure for type 1? As the saying goes, behind every great man, there’s a great woman. I particularly liked the part of the story where he admitted that after his son was diagnosed with type 1 diabetes, his wife literally became his son’s pancreas (which as parents of these children, we know very well) and she told him to do something useful in this regard, too. There is no doubt today she did the right thing. It was Melton in 2001, when President Bush in the US cut funding for embryonic stem cell research, who used private donations to create 17 lines of human stem cells and distributed them free of charge to researchers around the world. In 2014, he announced a method to create virtually unlimited quantities of beta cells from human stem cells, which produce insulin – a significant milestone in the world of medicine and the treatment of this chronic non-communicable disease. Melton decided to do everything to cure diabetes, and thanks to his work, the world is closer to this reality than ever before. According to him, to solve the question of type 1 diabetes, two basic problems need to be overcome: the absence of beta cells and the immune attack. The first problem has been solved (although instead of the planned 3-4 years, it took 15 years), work is underway on the second. According to Melton, cells derived from animals are not the solution – we don’t need animals when we can create cells from human donors. One of the questions was also the cost of treatment. As he says, “nobody wants a treatment that would be available only to the rich people”. It’s not a rare disease, and with millions of people affected worldwide, the price will drastically decrease.

The dream of Doug Melton was heard from the mouths of scientists that Saturday afternoon several times: Imagine, as parents, you come to the hospital with your child, where you’re told – your child has type 1 diabetes, I’m sorry, but we have a solution. Then the doctor stands up and takes stem cells from the refrigerator, those will be injected directly on the spot. They may last for 1 year, maybe 10, we don’t know yet. “But we can produce them without limit.” And if you have chosen the path of research in your profession, here is Melton’s message: Focus on what should be done, not what is possible to do. At the end of this conversation, we could all unanimously agree: “This problem can be solved, only together can we do it.”

From across the ocean, Burcin Ekser from Indiana University also joined us, focusing on xenotransplantation. This research has a history of more than 50 years, involving cells from different species, such as pigs to humans. Ekser provided extensive insights into the possibilities of transplanting various organs of porcine origin. Although pigs are further from the human species, they represent an easily modifiable and accessible source. However, the risk of rejection is higher in cross-species transplantation. Implanted cells were both with and without protective shield and have the potential to survive for hundreds of days. Nonetheless, there are still many unanswered questions regarding xenotransplantation.

The contributions from Laura Monaco and Alessia Neroni were both delightful and insightful. These researchers are part of the DRI team and thanks to public donations they participate in scholarship study stays at some of the best research centers, the Joslin Diabetes Center in Boston, US, and the Steno Diabetes Center in Aarhus, Denmark.

Round Tables

After the initial session, participants had the chance to participate in discussions with experts who were ready to answer any questions they had. There were a total of 6 groups. I chose:

Betta is Better

• Kidney, pancreas, and islet cell transplants – standard therapy
• Stem cells – ongoing clinical trials; the selected candidate will receive a dose within 60 days; some individuals have already received cells but not the full dose
• Interesting facts: Attacked beta cells die sooner in children; stem cells are derived from blood samples, personalized cells can be created; a protective shield is made of polymer; research also focuses on biomaterials.

Diabetes and Complications

• Interesting facts: Diabetes primarily affects the eyes in complications; for type 1 diabetes, we can talk about transplantation even before dialysis is necessary (contact the transplant center); balanced diabetes compensation is essential.

Diabetes and Technologies

• Interesting facts: Yes to technologies – from time zero – “because we can achieve things we couldn’t imagine we could, just three years ago.”

Note: Technologies refer to a closed-loop system; suitability – each case needs individual consideration.

“What’s Hot and What’s New – at the boundaries of DRI“

The concluding block belonged to the researchers of the center, who faced the challenging task of explaining their work in simple terms to all present. I must say they handled their roles brilliantly. Valeria Sordi and Raniero Chimienti told us more about stem cells, as well as the planned cell factory, the ability to personalize cells today, and the search for ways to limit their aging. Antonio Citro talked about tissue engineering, Paolo Monti about Immunological tolerance, Gianpaolo Zerbini provided insight into new perspectives in the prevention of diabetic retinopathy, Vito Lampasona talked about antibodies as biomarkers, and in the end, emotions were once again present. Lorenzo Piemonti presented DRI’s vision for the future, and I must admit that although I’ve had the opportunity to hear his speech several times, keeping a dry eye until the end of his presentations always remains a challenge for me. In this block, I again remembered 2021 and my questions, this time with a feeling of satisfaction that there are truly exceptional people in the world who, for many years, tirelessly work on them and much more. With a sense of fulfillment, I realize that despite my initial experiences, I have persisted in asking questions, and over the years, I continue to discover more and more of the right places where my questions are answered appropriately.

Type 1 diabetes is a global burden, with annual costs exceeding $81 billion (3.5 times more than in 2008) for the 9 million people and children living with diabetes worldwide. It is no longer predominantly a disease affecting young people or children. Nearly 1.5 million new cases are diagnosed each year in children and young people up to 20 years old, accounting for 38%. The annual increase in deaths caused by type 1 diabetes by 3% indicates 175,000 deaths annually, with the costs of diabetes care skyrocketing (up to +686%; increase in insulin prices since 2001). Dire forecasts warn that by 2040, 15 million people worldwide will be living with this deasase. We need a cure NOW. Thirty-four years ago, the first person with type 1 diabetes received islet cell transplants in Milan. Six months later, in Milan, the first person with type 1 achieved insulin independence. Thirty-two years later, islet cell transplants in Italy were incorporated into the National Procedure Guideline for Diabetes Treatment. Among their other goals is to be more effective and applicable over a wider time span of diabetes development, before clinical manifestation and achieve numerous cell invisibility that last a lifetime.

“We Choose the Moon,” from the shared part of famous J.F. Kennedy’s speech, still resonates in my ears, and I have no doubt that scientists united in a common goal will indeed cure type 1 diabetes. The grand final round of questions and answers was concluded with thanks to all who contributed to the organization of the conference. Professor Piemonti did not forget to personally thank all of us in the audience for our participation. The presence and support of the Sostegno 70 association were integral and inseparable from the event. Among other things, they took care of the youngest – the children of the participants – through various activities all afternoon. Meeting the founder and president of the association in person for the first time after years of virtual interaction was one of the warmest and most respected meetings for me. Patricia Pappini was one of the first pillars, closest to my family shortly after the diagnosis.

It is always inspiring to see and be in places where the importance of connecting all stakeholders is understood, for making progress in the treatment, research, and care of people with type 1 diabetes. Improving communication, understanding new treatment options and procedures, increasing resources for research, supporting innovations in treatment, dismantling myths, breaking down stigmatization… all of this is part of the metaphorical journey to the Moon in Diabetology, which we can only achieve together. A few days after the conference, an email with thanks and a satisfaction questionnaire appeared in my inbox, a reminder to participate in Citizen Science, underscoring the high seriousness of collaboration and professionalism of organized event.

Are there similar events happening in your area? Let me know in the comments. Also, read about a similar format, the DiaCongress for patients and doctors organized by Motol in Prague, which is becoming an increasingly popular destination for Slovak patients and families living with type 1 diabetes, too. You can find my report from 2022 here. I mentioned it already regarding Motol in the Czech Republic, but the same applies to DRI; when you look at the professionalism, dedication, and humanity of the whole team, full of young faces, you can’t help but sincerely congratulate the person who leads them. The final applause spoke for everything.

If you are co-organizing (or would like to) a similar event for people in Slovakia, at any level, and would like to seek advice or share experiences, I would be happy if you reached out to me here.

Few more photos from the conference in my album here.