“We hope to develop therapies that tackle diabetes at its roots”

Is diabetes becoming an epidemic among children as well?

Willem Staels: “The number of children with type 1 diabetes in Europe has been rising for over 30 years. Type 1 is an autoimmune disease. Immune-related conditions in general seem to be on the rise. We’re also seeing type 2 diabetes — once known as ‘adult-onset’ — even in primary school children. In places like South America and among Indigenous communities in Canada, the disease is already reaching epidemic levels. It’s still rarer here, but rising childhood obesity — a major risk factor for type 2 — suggests that trend won’t stop on its own.”

“The addictive pull of fat, salt and sugar is not to be underestimated”

Where does current diabetes care fall short?

“Chronic care is still the standard. Children with type 2 usually start on oral medication. For type 1, insulin is needed straight away. That’s a heavy burden. Diabetes is a 24/7 condition — every meal, every bit of exercise, every night. There’s no ‘holiday’ from the disease. Frederick Banting already said it a century ago: ‘Insulin is a treatment, not a cure.’ We desperately need disease-modifying therapies that can slow or even reverse the condition.”

What new insights has your research uncovered?

“Our research focuses on the beta cell — the pancreas cell that produces insulin and is key to keeping blood sugar levels in check. In type 1 diabetes, the immune system attacks these cells. In type 2, they’re worn out from years of overwork due to fats and sugars. We’re exploring different avenues, including the transplantation of donor beta cells. That’s already being done in the clinic for a select group of patients with very unstable blood sugar levels — and with success. Some go years without needing insulin, and seem effectively cured. But the protection doesn’t last forever, and there simply aren’t enough donors to go round. Plus, it’s only available in specialised transplant centres like UZ Brussel.

Then there’s the immune system. It rejects foreign cells, so patients need immunosuppressive drugs — which come with increased risks of infections, abnormal cell growth, even cancer. That’s why we’re now focusing on stem cell therapy. How can we turn lab-grown stem cells into strong beta cells that regulate sugar levels automatically? We recently discovered that iron plays a crucial role in beta cell function. It’s not just a ‘building block’ — it’s more like ‘fuel’. If there’s a shortage or imbalance in iron metabolism, these cells become stressed and damaged more easily. By restoring or fine-tuning iron balance, we might not only help these cells survive longer but also make them work better. Our goal is to develop therapies that tackle diabetes at the root cause.”

When do you think this technique will be ready for use?

“The potential is huge. It could cure both type 1 and type 2 diabetes — though weight loss will always be key in type 2. But there are still hurdles. How can we stop the immune system from rejecting new beta cells without resorting to heavy-duty medication? Breakthroughs have been announced for 20 years now, often with great fanfare. I don’t want to commit to a hard deadline, but we’re closer than ever. Research is speeding up, and we’re already producing insulin-making beta cells good enough for clinical trials. The processes are improving all the time.”

What are the main health risks?

“With obesity, it’s not about the kilos themselves, but where the fat ends up. Subcutaneous fat is relatively harmless. But once that ‘storage space’ fills up, fat starts to settle deeper — in the liver, around the heart, kidneys, pancreas… That impairs how those organs work. We’re already seeing fatty liver and high blood pressure in children. Obesity in early life is the biggest predictor of obesity in adulthood. And it’s hard to shake off, with serious consequences: reduced organ function, insulin resistance, (pre)diabetes, cardiovascular disease and even cancer. The longer your body is in that state, the bigger the impact on your quality of life and life expectancy.

With type 1 diabetes, the danger isn’t just high blood sugar — it’s the dangerous swings. Low values can cause loss of consciousness or even seizures. High values aren’t felt right away, but over time they cause ‘sugar damage’ in small blood vessels, leading to complications like blindness and diabetic foot. We don’t see those in children yet, but if diabetes isn’t well controlled, complications in adulthood can become a major issue.”

How important is early detection?

“Hugely important. Diabetes often simmers for years. By the time symptoms show, up to 60% of beta cells may already be lost. That’s why we’re launching screening programmes to detect early changes. Hopefully we can influence the course of type 1 diabetes that way. The earlier it starts, the more aggressive it tends to be — and the faster the remaining beta cells disappear. You should always be alert to signs like excessive thirst, frequent urination, weight loss and fatigue. A simple finger prick or urine test is enough to rule out diabetes.”

“Research helps us improve and opens up new perspectives”

What’s your view on the evolution of diabetes technology?

“Technological progress is impressive. Insulin pumps and sensors increasingly automate insulin delivery, making life a bit easier. But tech isn’t the whole story. A child with little support at home, or a teenager who just wants to be a teenager, might forget to refill the pump or replace the sensor. People aren’t robots — alarms, faulty readings, skin irritation all bring new challenges. The ultimate goal is still to restore the natural function of the beta cell. That would ease the treatment burden for everyone — regardless of age or background — and give them more freedom.”

What motivates you as a doctor?

“As a paediatric endocrinologist, I get to support children on their journey to adulthood. I want diabetes to be part of their lives, not the whole story. It’s a balancing act: setting limits where needed, but with empathy and respect for their independence. The aim is for children to understand what’s good for them, so they rely less on healthcare providers. That trust — with the child and their parents — is central to everything I do. Together, we look for the best approach.”

You combine clinical work with research. Why is that combination so important to you?

“The reward in the clinic is immediate: every consultation makes a difference. With research, the payoff takes longer. You spend years on one topic, hit roadblocks, have to start again. That demands resilience and patience, but also fuels my curiosity. I want to understand things deeply and help move the field forward. Just doing clinical work would keep medicine as it is. Research lets us improve it and open up new possibilities. For me, it’s the perfect mix: challenging, meaningful, and incredibly rewarding. Honestly, I’d do it even if I didn’t get paid. The team spirit in the hospital and lab is a huge part of that — but above all, it’s just brilliant work.”