July 2019 - Diabetes Research Connection

Diabetes Research News
July 28, 2019

Researchers Identify a New Type of Diabetes

Many people are familiar with the two most common types of diabetes – type 1 diabetes and type 2 diabetes – but other forms exist such as gestational diabetes. According to a recent study, researchers have discovered another type as well: checkpoint inhibitor-associated autoimmune diabetes or CIADM.

Immune checkpoint inhibitors are often used in the treatment of advanced cancers to block programmed cell death-1 (PD-1) receptors. However, one of the potential adverse effects of anti-PD-1 therapy is CIADM. Patients who develop this condition experience a sudden loss of insulin as well as variable glycemic control and require insulin to manage the condition.

The retrospective cohort study included 538 patients who were treated for metastatic melanoma between March 2015 and March 2018. Patients had either received only anti-PD-1 therapy, a combination of anti-PD-1 and ipilimumab, or a combination of anti-PD-1 and either ipilimumab or a placebo. Of these 538 patients, six who received only anti-PD-1 and four who received anti-PD-1 and ipilimumab developed CIADM. Demographic information showed that 90 percent were male, the median age was 62, and only one patient had a prior history of diabetes. In addition, all 10 were negative for islet antigen 2 antibodies, insulin antibody, and zinc transporter 8 antibody.

These findings open doors for larger studies and more in-depth research into this condition, which is not the same as type 1 diabetes despite requiring insulin to manage blood glucose levels. The Diabetes Research Connection (DRC) is interested to see where this study will lead and what it may mean for the future of diabetes, treatment, and understanding of the disease.

The DRC provides essential funding for early career scientists focused on studying issues related to type 1 diabetes. These studies not only aim to advance understanding and improve diagnosis, treatment, and quality of life, but also to one day find a cure.

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Diabetes Research News
July 22, 2019

Could Hybrid Immune Cell Be Linked to Type 1 Diabetes?

Scientists understand a lot about the foundational cells that make up the body, but even still, they are always learning and discovering more. For instance, the body’s immune system is made of up B cells and T cells. These cells identify foreign invaders in the body – such as germs – and then attack and destroy them or create antibodies. In individuals with type 1 diabetes, these cells mistakenly destroy insulin-producing beta cells.

However, a recent study shows that scientists have discovered a hybrid cell that is a combination of both B cells and T cells. Not only does the surface of the cell have B cell and T cell receptors, it also expresses genes from both types of cells. In addition, these cells contain a unique genome sequence in B cell receptors that was only found in the cells of individuals with type 1 diabetes. Though some healthy individuals had this hybrid cell, they did not present with this specific B cell receptor sequence.

Upon further investigation, they found that this dual expresser cell binds very tightly to the HLA-DQ8 molecule, which is believed to play a major role in triggering the body’s attack on insulin-producing beta cells. Since this occurs in the early stages of type 1 diabetes development, researchers are interested in the potential for this discovery to one day support early diagnosis or prevention of the disease.

However, there are still many unanswered questions that exist. Scientists do not yet understand exactly how, why, when, or where the hybrid cells develop. While T cells originate in the thymus, B cells come from bone marrow and lymph nodes. Scientists are unclear where the overlap may occur that would combine these two distinct cells. They are also unsure why these dual expresser cells would go on to target insulin production.

This is the first time that this type of cell has been identified, so there is still a great deal of research that needs to be done. No one is exactly sure what this could mean for future understanding of type 1 diabetes and treatment options. That will come as more studies are done and more in-depth research is completed.

The Diabetes Research Connection (DRC) is excited to see where this discovery leads and the type of studies it generates. Though not involved with this study, the DRC provides critical funding to early career scientists for novel research projects related to type 1 diabetes. This is an integral part of advancing understanding and treatment of the disease.

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Diabetes Research News
July 15, 2019

Exploring the Link Between Disturbed Eating and Type 1 Diabetes

Managing type 1 diabetes requires careful monitoring of food intake, activity, blood sugar, and insulin administration. Depending on what a person eats and when, it impacts their blood glucose levels. A recent study found that around one-third of individuals between the ages of 16 and 28 experience issues with disturbed eating behavior (DEB). Furthermore, many report restricting or omitting insulin.

The study evaluated the responses of 300 participants to the Diabetes Eating Problem Survey-Revised (DEPS-R) as well as to questions regarding diabetes distress, depressive symptoms, and self-management of the disease. They were divided into four groups based on their DEPS-R scores for baseline and then one year later. The groups were low DEB (65.7%), increasing DEB (8%), decreasing DEB (7.3%), and persistent DEB (19%).

While mean DEPS-R scores were stable from baseline to one year later, the scores were higher in females than in males – 16.53 and 15.57 in females versus 8.71 and 8.96 in males. All groups reported varying levels of insulin restriction and omission, but it did not differ significantly between males and females.

Individuals who fell into the persistent DEB group showed the highest levels of diabetes distress and depressive symptoms while those in the low DEB group showed the lowest levels. The low DEB group also had the lowest HbA1c levels, while the persistent DEB group had the second highest. The study also found that “self-management decreased when DEB increased, and vice versa.” This could in turn lead to poorer glycemic control and increased health care costs.

The researchers found overall that DEB can occur at any age and any stage of the disease, but that evaluating adolescents and young adults for DEB and eating disorders may be beneficial in supporting better diabetes management and glycemic control.

The Diabetes Research Connection, though not involved with this study, supports early career scientists in conducting research aimed improving prevention and finding a cure for type 1 diabetes as well as minimizing complications and improving quality of life for individuals living with the disease. Through donations from individuals, corporations, and foundations, scientists can secure the critical funding they need to move forward with their research.

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Diabetes Research News
July 10, 2019

Could Type 1 Diabetes Slow Brain Development in Children?

Since type 1 diabetes occurs when the pancreas produces little to no insulin, it is often diagnosed in childhood when this deficiency become more apparent. The body is unable to naturally manage blood sugar levels since the immune system mistakenly attacks and destroys insulin-producing beta cells. This means that parents must take over this responsibility until children are able to effectively manage their condition on their own.

Many parents are hesitant to overtreat and end up allowing blood sugar levels to remain slightly elevated (hyperglycemia) rather than risk having them drop too low (hypoglycemia). Neither condition is desirable as they can both lead to health complications. The goal is to create a management plan that enables blood sugar levels to remain as normal as possible.

A recent study found that hyperglycemia in children with type 1 diabetes may actually slow brain development and impact brain structure, cognitive function, and sensory processing. The study followed 138 children with type 1 diabetes between the ages of four and seven. Participants had been living with diabetes for an average of 2.4 years. These children were compared to 67 age-matched controls without type 1 diabetes.

After approximately 4.5 years, researchers found that those children with type 1 diabetes had decrements in both full-scale and verbal IQ, which was associated with hyperglycemia and an average HbA1c of 8%. The target goal for children is an HbA1c of less than 7.5%.

However, a larger study found that although full-scale, verbal IQ, and vocabulary were lower in those with T1D, there was no significant difference in processing speed, memory, or learning scores compared to the control group. The brains of children with T1D seemed to compensate for areas where there were challenges, and executive function was similar between groups.

Nelly Mauras, MD, chief of the Division of Endocrinology, Diabetes, and Metabolism at Nemours Children’s Health System and part of the Diabetes Research in Children Network (DirecNet) noted, “We are not suggesting that these youngsters aren’t performing academically. So far, these differences have not translated into functional outcomes in performance, at least not yet.”

Researchers continue to follow these groups in order to gather more information and determine the impact over a longer duration of time. They are interested in learning more about whether advanced technology can make it easier to maintain near normal glucose levels and whether HbA1c guidelines should be lower than 7.5% for children with type 1 diabetes to minimize hyperglycemia.

The Diabetes Research Connection (DRC), though not involved with this study, will continue to follow study progress to see what future comparisons hold and how this may impact treatment options and guidelines for children with type 1 diabetes. Current results may stimulate new research opportunities and increase understanding of the greater impact of T1D on health and development. The DRC provides critical funding for early career scientists to pursue novel research projects related to type 1 diabetes.

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Diabetes Research News
July 1, 2019

Later Onset Type 1 Diabetes Often Misdiagnosed as Type 2

Type 1 diabetes used to be commonly known as juvenile diabetes because it was often diagnosed in childhood. In individuals with this disease, the body mistakenly attacks and destroys insulin-producing beta cells, and eventually the body is no longer able to generate enough insulin to support normal blood sugar levels. Therefore, individuals must monitor their own blood-glucose and inject themselves with insulin.

However, research has shown that around 42% of people with type 1 diabetes were diagnosed after age 30. A recent study found that some people are mistakenly diagnosed with type 2 diabetes instead due to the late onset of the disease as well as clinical and genetic characteristics. This can make it difficult to properly differentiate between the two conditions.

The study examined data from 583 participants diagnosed with diabetes after age 30 who are part of the Exeter Diabetes Alliance for Research in England (DARE). Their data was compared to 220 DARE participants with the same study criteria but who were diagnosed with type 1 diabetes before age 30.

The researchers wanted to know how many of those diagnosed after age 30 had severe endogenous insulin deficiency (meaning their body naturally produced little to no insulin on its own), whether diagnosed with type 1 or type 2 diabetes. Severe insulin deficiency is a classic sign of type 1 diabetes but C-peptide and other tests are not always conducted to check for this condition in adults age 30 or older. However, the study found that 21 percent of participants who were treated with insulin had this condition, and 38% of participants not treated with insulin at diagnosis had it.

Individuals who required rapid insulin within one year of diagnosis or who were treated with insulin within three years of diagnosis had a higher likelihood of severe endogenous insulin deficiency; 85% and 47% respectively. This means that they likely had type 1 diabetes rather than type 2, regardless of what their initial diagnosis was. Participants diagnosed after age 30 shared very similar clinical and biological characteristics with the younger cohort.

It is critical that physicians conduct necessary testing to differentiate type 1 from type 2 diabetes regardless of age of onset. There are often different protocols for treating each of these conditions, and individuals with type 1 diagnoses have greater access to necessary resources such as continuous glucose monitoring (CGM) devices, insulin-pump therapy, and targeted diabetes education.

With more awareness of the frequency of type 1 diabetes onset after age 30 and associated characteristics, hopefully medical providers will be better able to assess and accurately diagnose this condition more quickly to provide essential treatment.

The Diabetes Research Connection (DRC) strives to support early career scientists in pursuing novel research studies that focus on the prevention, diagnosis, and treatment of type 1 diabetes as well as improving quality of life for individuals living with this disease. Research is critical to one day finding a cure.

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