September 2019 - Diabetes Research Connection

Diabetes Research News
September 30, 2019

Could Gluten Impact HbA1c Levels?

Researchers know that type 1 diabetes involves the body’s immune system mistakenly attacking and destroying insulin-producing beta cells, and that this can be affected by autoantibodies and antibodies. However, the body produces antibodies in response to many diseases, including celiac disease.

In a recent study, researchers explored the relationship between patients with celiac disease achieving antibody-negativity versus staying antibody-positive and the potential impact on type 1 diabetes. When individuals with celiac disease stop eating gluten, the body stops producing specific antibodies that react to gluten. Tight management of the disease may produce antibody-negative results during testing. If the person continues to eat some gluten, they will remain antibody-positive.

Scientists compared 608 pediatric patients with type 1 diabetes (T1D) and biopsy-proven celiac disease with 26,833 patients with T1D only. They found that those patients with both diseases who remained antibody-negative had lower HbA1c levels than those who were antibody-positive. The study also showed that, compared to patients with only T1D, those who had both celiac disease and T1D and were antibody-negative had lower total cholesterol, LDL-cholesterol, and frequency of dyslipidemia as well.

Though more research is necessary, achieving constant antibody-negative status may be associated with improved metabolic control and growth and have an impact on HbA1c levels. This could lead the way to advancements in treatment options for individuals with celiac disease and type 1 diabetes and perhaps type 1 diabetes alone as well.

Diabetes Research Connection (DRC) stays abreast of the latest developments in the field and supports early career scientists in pursuing peer-reviewed, novel research studies on type 1 diabetes. It is through these types of projects that researchers learn more about diagnosis, treatment, and prevention of this disease and move closer toward finding a cure. Learn more about current projects and how to support these efforts by visiting http://diabetesresearchconnection.org.

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Diabetes Research News
September 23, 2019

Evaluating the Effect of Specific T Cells on Type 1 Diabetes Risk and Treatment

As researchers delve more deeply into trying to understand the origins of type 1 diabetes (T1D), they become increasingly aware that there is not a single disease pathogenesis, but rather multiple paths that vary from person to person. While they know that T1D results from the immune system attacking and destroying insulin-producing beta cells in the pancreas, there may be several different factors that contribute to this risk.

A recent study examined a variety of T cells, T cell receptors, antigens, and autoantibodies that may play a role in the development of T1D. One common factor they found was that individuals with an elevated level of islet autoantibodies in the peripheral blood are at increased risk of developing T1D within their lifetime. Researchers also know that in addition to risk genes, human leukocyte antigen (HLA) genes and the autoantibody glutamic acid decarboxylase (GAD) could vary from person to person and impact the effectiveness of targeted therapies. Children who possess two or more islet autoantibodies have around an “85% chance of developing T1D within 15 years and nearly a 100% lifetime risk for disease development.”

However, the mere presence of islet autoantibodies does not demonstrate disease state, because it could be years before clinical T1D presentation. In its early stage (stage 1), while the autoantibodies are present, beta cell function remains normal. As risk for T1D advances (stage 2), metabolic abnormalities develop. Finally, with T1D onset (stage 3), there is both a presence of autoantibodies and loss of beta cell function in regard to blood glucose. The staging paradigm was derived from data from the United States’ Diabetes AutoImmunity Study in the Young (DAISY), Finland’s Type 1 Diabetes Prediction and Prevention Study (DIPP), and Germany’s BABYDIAB studies.

Given the similarities of mouse models and human models when it comes to diabetes, mouse models are often used to study disease risk, evaluate pathogenesis, and assess potential treatment options. Researchers have found that specific antigens and T cells affect pancreatic islets differently. Understanding these antigen subsets could be critical in determining effective clinical therapeutics for prevention and treatment.

Thanks to the Network for Pancreatic Organ Donors (nPOD), more than 150 cases have been collected from organ donors with T1D since 2007, as well as more than 150 from non-diabetic donors and dozens of donors with autoantibodies but no clinical diabetes. These tissue donations have provided researchers with islets, cells, and data from multiple facets of the ody that contribute to T1D risk.

Understanding tissue specific T cells, antigens, and autoantibodies may help identify biomarkers of disease activity which could improve targeted therapeutic interventions. Eventually, this may help reduce risk of T1D by creating early intervention strategies.

While not involved with this study, Diabetes Research Connection (DRC) is focused on advancing understanding of T1D and improving prevention, diagnosis, and treatment options as well as progress toward a cure. Early career scientists receive critical funding to pursue novel, peer-reviewed research projects regarding multiple aspects of T1D. Learn more by visiting http://diabetesresearchconnection.org.

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Diabetes Research News
September 16, 2019

Examining the Impact of Intensive Glucose-Lowering Treatment on Hypoglycemia Risk

One of the key indicators in effective diabetes management is HbA1c level. In healthy, non-diabetic adults, the target range is 4% to 5.6%, while in individuals with diabetes, the goal is to maintain an HbA1c level of less than 7%. However, some treatment guidelines aim for achieving levels of 5.6% or less, or between 5.7% and 6.4%.

Striving for these lower HbA1c levels through intensive glucose-lowering therapy may prove more risky than beneficial, though, especially for adults who are considered clinically complex, according to a recent study. These individuals may benefit from less intensive treatment and slightly higher target HbA1c levels to reduce risk of emergency department visits and hospitalizations for severe hypoglycemia.

The study included data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, and “participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions.” They were considered to be engaged in intensive treatment if their HbA1c level was below 5.6% and they took any glucose-lowering medication, or if their HbA1c level was between 5.7% and 6.4% and they took two or more glucose-lowering medications.

In addition to NHANES data, other population-level studies were included as well when comparing data and outcomes. Overall, overtreatment was estimated to occur in up to 50% of non-clinically complex patients and up to 60% of clinically complex patients.

For the study, 662 nonpregnant adults who had diabetes and maintained HbA1c levels of less than 7.0% were used to represent around 10.7 million adults with diabetes in the United States. Of these participants, 20.1% were age 75 or older, 21.5% were treated intensively, and 32.3% were considered clinically complex. The researchers estimated that over two years, there would be 31,511 hospitalizations and 30,954 emergency department visits for severe hypoglycemia, and that around 4,774 hospitalizations and 4,804 ED visits could be directly attributed to intensive glucose-lowering therapies.

The study found that aggressive treatment of diabetes to achieve lower HbA1c levels could actually have a negative effect on overall health, especially for clinically complex patients who experienced severe hypoglycemic events. It is recommended that many elderly and clinically complex patients avoid intensive treatments and follow relaxed glycemic targets. Recommended HbA1c levels should be evaluated on an individual basis and take into account patient health, comorbidities, and clinical complexity.

There were limitations to this study, and researchers note that “true numbers are likely to much higher” regarding hypoglycemic events and the number that are directly attributable to intensive glucose-lowering therapy.

Type 1 diabetes management is a complex process, and researchers are continually advancing their understanding of the disease and effective treatment options. Diabetes Research Connection (DRC) follows advancements in the field and potential impact on individuals living with T1D.

DRC supports novel, peer-reviewed research studies regarding the diagnosis, treatment, and quality of life for those living with the disease. Learn more about current projects and how to donate to these efforts by visiting http://diabetesresearchconnection.org.

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Diabetes Research News
September 10, 2019

Could Peripheral T Helper Cells Be Linked to Type 1 Diabetes Risk?

Type 1 diabetes (T1D) is a complex disease. Researchers believe that both genetics and autoantibodies play a role in development of the disease. In individuals with T1D, the immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. A new study has found that peripheral T helper cells may play a role in initiating this process.

The study showed that children with T1D, as well as those who were autoantibody-positive who developed the disease later on, both had an increase in the amount of peripheral T helper cells circulating in their blood. Researchers believe that much like follicular helper T cells, peripheral T helper cells may also be involved in activating B cells which target against proteins in pancreatic islet cells and contribute to the development of T1D.

The ability to identify children who are at increased risk for the disease due to genetics as well as the elevated presence of peripheral T helper cells may improve options for proactively monitoring and treating T1D. It could also support the development of new immunotherapies for the disease.

More research is necessary to better understand the role of this T-cell subset and how it impacts type 1 diabetes risk and development of the disease as well as how it could improve treatment or prevention options. Though not involved with this study, Diabetes Research Connection (DRC) follows the latest developments and advancements regarding type 1 diabetes understanding, treatment, and prevention.

DRC provides critical funding for early career scientists pursuing novel research studies related to the disease and hopes to one day find a cure. To learn more about current projects or how to help, visit http://diabetesresearchconnection.org.

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Diabetes Research News
September 4, 2019

Does Timing of Exercise Affect Blood Glucose Levels for Individuals with Type 1 Diabetes?

Regular exercise is an important part of maintaining good health, and this goes for individuals with type 1 diabetes (T1D) as well. However, the question has often risen as to whether the time of day that individuals engage in exercise has an impact on their blood sugar management. A recent study compared results when resistance training was completed in the morning during a fasting state versus in the afternoon after blood sugar had been managed throughout the day.

The randomized study involved 12 participants between the ages of 18 and 50 who had been diagnosed with T1D for a least a year, did not take any medications (aside from insulin) that may impact their blood glucose levels, had no limitations on required exercises, and did not perform shift work. They were asked to keep a log of their food intake and insulin dosage because they were blinded to continuous glucose monitoring.

The results showed that engaging in resistance exercise in the morning (7 a.m.) led to a higher risk of hyperglycemic episodes than exercising in the afternoon (5 p.m.). Blood glucose levels tended to be higher during morning exercise and the 60-minute recovery period as well as during the next six hours. However, with afternoon exercise, blood glucose levels declined during exercise and returned almost to baseline during recovery. There was also less glycemic variability during the six hours post exercise.

It is essential that individuals with type 1 diabetes talk to their doctor before starting or changing their exercise routine, and that they carefully monitor their blood glucose before and after physical activity. Studies like these play an important role in helping individuals with T1D to better manage the disease and improve their quality of life.

Diabetes Research Connection (DRC) stays abreast of the latest developments in the field and supports early career scientists in pursuing novel, peer-reviewed research projects focused on prevention, treatment, and an eventual cure for T1D as well as improvement of quality of life. Click to learn more about current projects and provide support.

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