TrialNet is a research effort that seeks to identify preventative and treatment strategies for type 1 diabetes. New data was just released at the American Diabetes Association (ADA) 80th Scientific Sessions. Here are the major highlights:
1. The optimal age for screening children at risk for type 1 diabetes
It is possible to screen at-risk individuals for the development of autoantibodies that are predictive of T1D development. This can reduce the likelihood of health complications due to a late diagnosis as well as allow patients to enroll in clinical trials aimed at preventing or delaying T1D onset. Researchers recently evaluated the sensitivity, specificity and predictive values based on the screening ages of children at risk for developing T1D. They concluded that it was best for two separate screenings to occur; one around the age of 2-3 years and another at around the age of 5-6 years. “Our data represent a starting point for these considerations that should be customized based on the population’s underlying disease characteristics and public health infrastructure,” they added.
2. Identifying those at risk
How do we identify those who are most at risk for developing T1D? Currently, beta cell function analysis, utilizing glucose tolerance tests and other, more invasive measures, are used. New research demonstrates that using a validated (in type 2 diabetes) mathematical tool may be able to help make this assessment for those at risk for type 1 diabetes from “fasting glucose and insulin measurements from a single time point.” This could afford a fast and relatively non-invasive way to predict risk in the future.
3. Antibody-positive individuals with very slow progression to type 1 diabetes
It is established that people can develop T1D at different rates, after the initial appearance of autoantibodies. New research aimed to characterize the features of “long-term non-progressors.” Interestingly, data revealed that those whose disease onset did not progress long after autoantibody detection, still had a decline in beta cell function, but nevertheless exhibited largely stable glucose profiles and c-peptide levels. Researchers speculate that glucose tolerance testing in those with autoantibodies may help identify those who are less likely to progress to T1D.
4. Pancreas volume and type 1 diabetes progression
New research demonstrates that not only is pancreas size at the onset of T1D and in those at risk smaller, pancreas size is also predictive of T1D risk. The study evaluated those with “stage 1” T1D (those who have two or more autoantibodies, but normal glucose tolerance) and found that their pancreas volume was significantly smaller than that of healthy controls (but significantly larger than those with “stage 3” T1D (showing autoimmunity and hyperglycemia, with symptoms). Although the sample size was relatively small, the data indicate that pancreas size (as measured by MRI) could be a predictive indicator of T1D development.
5. Oral insulin for those at risk of developing type 1 diabetes
Relatives of people with type 1 diabetes (T1D) who were identified as “high-risk” for also developing the condition participated in a prevention trial that used oral insulin (OI) in this population. While overall, the treatment did not appear to be effective in preventing T1D in initial analyses, a further analysis of patient subgroups revealed an interesting trend. Among those who were identified as being at the highest risk for developing T1D (high auto-antibody levels; hindered first-phase insulin response), data indicate that OI can “slow insulin decline”.
Read more about TrialNet and the work they’re doing here:
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