Welcome to our daily summary of type 1 diabetes (T1D) research highlights from the ADA’s 73rd Scientific Sessions! Each night, we will be posting summaries of notable sessions and presentations. Below are two relevant sessions from Friday, June 21.
The fact that T1D is a complicated disease was clear from each of the presenters at this session focused on the “dialogue” between the beta cell and the immune system in the early stages of T1D. This area of research is among the most exciting as JDRF-supported researchers and others are unraveling the previously unknown role that stressed beta cells play in the T1D disease process. T1D is no longer as simple as the immune system attacking the beta cells. It now appears that triggers such as obesity, insulin resistance, circulating free fatty acids, viruses, or dying cell fragments may prompt the “stress” in the beta cells’ protein-production machinery. This stress leads to inflammation that could be the start of the autoimmune process. One presenter suggested that the inflammatory process may even be part of the beta cells self-defense mechanism against infections.
Considerable research has been conducted on one pathway related to oxidative stress in beta cells controlled by a protein called TXNIP. Anath Shalev, M.D., professor of medicine and director of the University of Alabama at Birmington’s Comprehensive Diabetes Center reviewed an extensive dataset demonstrating the key role that TXNIP plays in beta cell stress and death in mice. Studies with the anti-hypertensive drug verapamil, that blocks TXNIP, showed it prevents beta cell death in mice with induced diabetes and it also appears active in isolated human islets. Unfortunately, due to its strong anti-hypertensive effect, it’s not a good candidate for a human T1D trial, but it may point the way towards similar molecules that could be tested in humans to see how they affect the T1D disease process in people by blocking the cycle of beta cell stress and death.
The first two presenters during this joint JDRF and ADA symposium highlighted some aspects of T1D care we often take for granted in the wealthier, developed countries. Jaako Tuomilehto, M.D., Ph.D., professor of epidemiology at the University of Helsinki and John Yudkin, M.D., Ph.D., professor of medicine at University College London, painted a sobering image of the generally inadequate level of T1D care in low and moderate income countries that lack the necessary resources to properly diagnose and treat individuals with T1D. The survival of individuals with T1D is low but improving in many of the poorest countries. As a result, the total number of people living with the disease remains low, although the number of new cases is growing just as it is in many of the wealthier, more developed countries. Targeted programs to improve care in low and moderate income countries have dramatically changed the situation, but it takes more than just supplying insulin. Insulin is necessary, but not enough for survival. It requires syringes, diagnostics, and trained health care professionals to really change the situation in some of these countries.
The International Insulin Foundation has started an ambitious “100 Campaign” to provide 100% access to insulin supplies around the world by 2022–the 100th anniversary of the first discovery and use of insulin. Dr. Yudkin also noted that, so far, T1D in low to moderate income countries has lacked the active patient advocacy groups, like JDRF, and that can be a catalyst for local change.
Other presenters reviewed the potential benefit from broader screening for T1D genetic risk markers and autoantibodies among the general population in the developed countries. Based on the experience of screening over 400,000 individuals for such risk markers in the TEDDY study, William Hagopian, M.D., clinical associate professor of medicine at the University of Washington, presented a potentially cost effective strategy of early screening of all children for the genetic risk factors and autoantibodies of T1D. He proposed that the costs of such screening could be offset by a reduction in the costs of hospitalizations for those with diabetic ketoacidosis–which remains common and steady in the U.S. Among other benefits, such large observational studies like TEDDY provide the data to help make decision about implementing new health care policies and improving T1D care even in the wealthier countries.