DRC & Research News

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Multiple Daily Injections May Improve Glycemic Control During Pregnancy for Women with T1D

Effectively managing blood sugar can be difficult in normal situations, but it can be even more challenging during pregnancy. Women must be cognizant of not only their own health, but also that of their unborn child. Infants are at risk for neonatal hypoglycemia. A recent study examined the impact of multiple daily injections (MDI) versus using an insulin pump on glycemic control during pregnancy for women with type 1 diabetes.

The study involved 123 women using MDI therapy and 125 women with insulin pumps. The researchers based the study on the treatment the women were already using prior to the trial; they did not assign a treatment method. Participants spanned multiple countries including the United States, Canada, England, Ireland, Scotland, Spain, and Italy. Women entered the study during their first trimester, and it lasted until they were at 34 weeks of gestation.

During this time, HbA1c levels were measured. The results showed that both treatment methods were equally effective during the first trimester with no statistically significant differences. However, at 34 weeks gestation, women who used MDI therapy showed a greater decrease in HbA1c levels versus women using insulin pumps. In addition, insulin pump users reported higher levels of gestational hypertension, neonatal hypoglycemia, and neonatal intensive care unit admissions for longer than 24 hours. However, these women also reported lower levels of hypoglycemia-related anxiety than those using MDI therapy, but also had lower levels of general well-being.

Overall, it appeared that MDI therapy resulted in greater decreases in HbA1c levels and improved glycemic control. There is still more research necessary, however, to verify these results. There were several factors that may have influenced findings and outcomes.

This study shows the importance of understanding the effects of T1D on different conditions such as pregnancy and the value of researching various treatment options to help women make more informed decisions regarding their health. Though not involved in this study, the Diabetes Research Connection follows the latest trends and developments in the field and supports early career scientists by providing critical funding for novel research regarding T1D. Continued funding is essential for advancing research and diabetes care. To learn more, visit http://diabetesresearchconnection.org.

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20 Years Later: The Impact of the Edmonton Protocol

Management and treatment of type 1 diabetes have advanced over the years, but it is interesting to see what has withstood the test of time. For instance, islet cell transplantation (ICT) was first used in humans in 1989. Though the protocol changed a bit in 2000, the concept has remained relatively the same ever since. It is known as the Edmonton Protocol.

Researchers have followed the Edmonton Protocol since 1999, tracking factors such as the number of procedures, adverse events, and insulin independence. Studies have shown that insulin independence rates have been fairly consistent from 1999 through 2015 with around 50% of patients maintaining insulin independence after one year, and 25% maintaining insulin independence after five years. In addition, fewer patients have experienced adverse events over the years, and whole-body immunosuppression has become more localized. However, the number of centers performing ICT and the number of patients receiving this treatment have also declined.

The Protocol continues to rely on the use of cadaver islet cells which are inserted into the body of a patient with T1D.  The transplanted cells are protected by immune suppression or some type of encapsulation to reduce the risk of the body attacking and destroying these cells.

One challenge that has persisted over the years is identifying a sustainable source of islet cells aside from cadavers. Researchers have been testing methods for using human stem cells or animal islet cells, but more tests are needed to potentially make these options feasible. Furthermore, the issue remains of protecting cells in the long-term. Currently, the best option is immunosuppression, but even that has limited effectiveness. While there have been advances made in the medications and encapsulation devices used, there is still work that needs to be done to address undesirable side effects such as decreased ability of the body to fight off diseases or infection.

It is interesting to see how the Edmonton Protocol has remained the standard for ICT for 20 years, and the Diabetes Research Connection (DRC) continues to follow progress and changes related to this type of treatment for T1D. T1D continues to affect around 1.25 million Americans, and researchers are always looking for improved options for treating, managing, and potentially curing this disease.

The DRC provides necessary funding to early career scientists to conduct novel research studies related to type 1 diabetes. These projects are aimed at preventing and curing T1D as well as minimizing complications and improving quality of life for those living with this disease. To learn more about current research projects and support these efforts, visit http://diabetesresearchconnection.org.

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Where is Diabetes Research Connection headed in 2019?

Since 2015, we have funded 17 innovative, peer-reviewed type 1 diabetes (T1D) projects and distributed $700,000 directly to early-career scientists, building a pipeline of talented T1D researchers. In partnership with our community, the main initiative in 2019 is to raise $300,000 to fund 4-10 of the most promising T1D research projects.

This year, we want to complete our $1M research campaign and accomplish the following goals:

  1. Continue to fund the most promising and innovative science that will advance the continuum of T1D research for a cure and ways to better care for those with the disease.
  2. Be a catalyst in changing the paradigm for how diabetes research is currently funded in the U.S.
  3. Publish new research project findings online and in respected journals to advance the industry.
  4. Ensure transparency by allowing supporters to choose which research they believe to be the most promising and may eliminate this disease.

Since 2015, 100% of funds designated for research went directly to the scientists’ lab. We are committed to continuing this in 2019.

For a summary of the accomplishments in 2018, click here. We will update you throughout 2019 on the progress of our $1M research campaign. We believe it takes a community to connect for a cure and together we make the difference!

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Diabetic Ketoacidosis Risk May Increase with Cannabis Use

Legalization of recreational and medicinal cannabis use has increased throughout the United States, but that does not mean that it does not come with risks. While cannabis can have positive effects for certain conditions, it may also be dangerous for others. A recent study found that using cannabis may double the risk of individuals with type 1 diabetes of developing diabetic ketoacidosis.

In a small, self-reported study of 450 individuals in Colorado with type 1 diabetes, approximately 30% reported using cannabis within the past 12 months. Of that group, around 40% smoked, used edibles, or vaped at least four times per week. The study found that while 8.2% of non-users had been hospitalized for diabetic ketoacidosis within the last year, this jumped to more than 20% for cannabis users. Furthermore, individuals with type 1 diabetes who used cannabis also had higher average HbA1c levels than non-users. Researchers believe the increased risk may come from the fact that “cannabinoids alter gut motility and cause hyperemesis.â€

However, there is still more research necessary to further explore this risk as the study had several limitations. Many of the participants who reported using cannabis were younger with lower income and lower use of diabetes technology such as insulin pumps and continuous glucose monitoring (CGM). In addition, access to healthcare was not taken into consideration. Furthermore, some participants may have had underlying conditions that also impacted their risk of developing diabetic ketoacidosis.

Regardless, this study opens doors for more in-depth research regarding the effects of cannabis use on type 1 diabetes. It is important to understand how this drug may impact health, treatment, and quality of life.

The Diabetes Research Connection (DRC), though not involved with this study, strives to support novel research studies regarding all aspects of type 1 diabetes by providing essential funding to early career scientists. This is made possible by donations from individuals, corporations, and foundations, and 100% of research funds go directly to the scientists. To learn more about current projects and how to help, visit http://diabetesresearchconnection.org.

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Researchers Examine Gut Bacteria in Children for Risk Factors for T1D

In an effort to better understand how type 1 diabetes may develop, researchers took a closer look at how gut health changes from infancy through childhood and into adulthood. They used data collected through The Environmental Determinants of Diabetes in Youth (TEDDY) study, which utilized reports from Finnish, German, Italian, Mexican, American, and Turkish children. This particular study on gut bacteria focused on 783 children between the ages of three months and five years from Finland, Germany, Sweden, and the United States.

Some of the factors they examined were whether children were breastfed or formula fed and for how long, any illnesses they contracted, antibiotics they took, environmental changes, and life experiences. Their gut microbial profile was determined through stool samples. One interesting finding was that when there were more Bacteroides species and a decreased production of short-chain fatty acids, there was an increased susceptibility to islet autoimmunity (IA) or type 1 diabetes (T1D).

The researchers found that the gut microbiomes differed greatly between participants, and there was a marked difference in children who were breastfed versus those that were not, as well as once solid foods were introduced into their diet. Breastfeeding showed higher levels of an enzyme that helps with milk fermentation, while solid foods increased enzymes that help metabolize fiber. In addition, participants who had taken oral antibiotics showed disrupted microbial stability along with decreases in some strains of Bifidobacterium. However, early probiotic supplementation helped protect control subjects against islet autoimmunity.

All of these factors may play a role in the development of islet autoimmunity or T1D. This study has increased awareness of the role that environmental factors may play in T1D along with genetics. There are still numerous issues this study did not address, but it is a strong starting point for further research, especially when it comes to the influence of breastfeeding and oral antibiotics on the development of T1D.

The Diabetes Research Connection (DRC) is interested to see how this study may impact future research in T1D and furthering the understanding of factors related to disease development and prevention. The DRC supports early career scientists pursuing novel research related to the prevention and treatment of T1D as well as improved quality of life for individuals living with this disease. Learn more about current studies and how to help by visiting http://diabetesresearchconnection.org.

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Nasal Glucagon May Become New Option for Treating Hypoglycemia

When blood sugar drops and hypoglycemia occurs, it is critical for individuals with type 1 diabetes to receive immediate treatment to raise their blood sugar. If left untreated, it can lead to severe confusion, seizures, or even loss of consciousness. One of the main ways of treating hypoglycemia is administering glucagon.

Glucagon is a hormone that stimulates the body to convert glycogen into glucose. It also keeps the liver from consuming too much glucose so that it can be circulated in the bloodstream instead. Traditionally, glucagon is delivered through an intramuscular injection. A solution is mixed to dissolve the glucagon, then it is administered by syringe.

However, many caregivers – or even bystanders – may be hesitant to give someone else a shot of glucagon. Preparing the syringe and shot is a multistep process and can be confusing if the person is not properly trained. Plus, they are under considerable stress in emergency situations where it must be given, which can complicate things even further.

A new study has found that nasal glucagon may be just as effective as intramuscular glucagon in raising blood sugar levels during episodes of hypoglycemia. There is no preparation necessary before administering the medication. It is a powder that comes in a single-use device that is sprayed up the nose. It isn’t even necessary for the patient to inhale because the powder is absorbed on its own.

Both treatment methods were tested on 70 adult participants with type 1 diabetes. A state of hypoglycemia was induced, and then they were treated with either the intramuscular or nasal glucagon. One to seven days later, the process was repeated, and the other form of medication was administered. In 100 percent of cases, hypoglycemia was reversed and participants had no serious adverse events. In 97 percent of cases, treatment success was achieved within 15 minutes.

This new treatment option was presented at the European Association for the Study of Diabetes (EASD) by Leona Plum-Moerschel, MD, of Profil Mainz, Germany. According to Plum-Moerschel, “I think we can all agree that the safety profile is very much acceptable for an emergency treatment. I personally would expect that, due to its simplicity of use, nasal glucagon will create a greater community who can render quick aid in a rescue situation.â€

The Diabetes Research Connection (DRC) is interested to see if this nasal formulation will be brought to market and how it will affect the treatment of hypoglycemia in children and adults. It is encouraging to see treatment options becoming more user-friendly so that even non-medical personnel can effectively administer emergency medications.

The DRC supports research geared toward the treatment and prevention of type 1 diabetes, as well as improvement of quality of life for those living with the disease. Access to funding is essential for scientists to continue advancing their research, and the DRC provides these types of resources. To learn more about current projects and donate to support these efforts, visit http://diabetesresearchconnection.org.

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More Adults May have Type 1 Diabetes Than Previously Thought

Type 1 diabetes (T1D) used to be known as juvenile diabetes because it is often first diagnosed during childhood. Since the pancreas produces little to no insulin, difficulty regulating blood sugar is typically noticed early on. However, that is not always the case. There are also many individuals who are not diagnosed with T1D until after age 30. In addition, they may be mistakenly identified as having type 2 diabetes rather than type 1.

A recent study compared data from the UK Biobank and also conducted clinical trials to determine how adults are diagnosed and treated when diabetes is suspected. Many people were initially diagnosed with type 2 diabetes and did not receive insulin treatment. They used an oral glucose-lowering medication in order to manage their blood sugar. But even when using rapid acting insulin, some still had difficulty with blood sugar control.

Approximately 5 percent of adults diagnosed with T2D actually have T1D. While this may not seem significant, proper diagnosis is critical to providing accurate treatment and education for patients. In addition, insurance may not cover the cost of supplies for those with T2D, but insulin pumps and continuous glucose monitors may be covered for those with T1D. This can make a major difference in care for many people.

The study involved nearly 600 adults from South West England who were diagnosed with diabetes after age 30 between 2007 and 2017. Results showed that 123 participants (21 percent) had type 1 diabetes with severe insulin deficiency requiring continuous insulin treatment within three years of diagnosis. There were 306 participants diagnosed with type 2 diabetes based on a peptide level of 600 pmol/L or greater for at least three years after initial diagnosis. Another 115 participants were not included in the analysis due to indeterminate results. The study also included 220 participants who had been diagnosed with T1D at age 30 or younger for comparison purposes.

While symptoms are often similar, the study found that “rapid insulin requirement was highly predictive of late-onset type 1 diabetes, with 84 percent requiring insulin within 1 year. And of all the patients treated with insulin within 3 years, 57 percent developed sever endogenous insulin deficiency consistent with type 1 diabetes.†Compared to participants with T2D, those with T1D typically had a lower BMI, were more likely to have a positive islet autoantibody test, and had higher genetic risk scores for T1D.

It can be difficult to differentiate between the two types of diabetes, but medical providers should carefully monitor those they believe may have T1D and conduct related tests to determine whether they should be treated initially using insulin as opposed to an oral medication.

The study was presented at the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting by Nicholas J. Thomas, MD, from the University of Exeter, United Kingdom. Dr. Thomas’ team is working on developing algorithms to improve the accuracy of diabetes diagnoses in order to provide the best care for patients.

Accurate diagnosis of type 1 or type 2 diabetes is essential for effective care and patient education. The Diabetes Research Connection supports research related to T1D and advancing understanding related to the diagnosis, treatment, and prevention of this disease. Early career scientists are provided with up to $70,000 in funding to conduct peer-reviewed, novel research studies. Learn more and find a project to support by visiting http://diabetesresearchconnection.org.

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Building a Pipeline of Young Researchers

New and innovative research is essential to continuing to expand scientific knowledge and improve the future of healthcare. Yet over the years, the biomedical community has seen a troubling downward trend in funding, support, and opportunities for young researchers. A study published in the Proceedings of the National Academy of Sciences of the United States of America investigated some potential factors for why investigators are struggling early on in their careers and not receiving as much funding to stimulate independent research.

For years, attaining an R01 from the National Institutes of Health (NIH) has been a prerequisite for young biomedical researchers to become independent investigators and start their own laboratories. Yet the average age that they receive their first R01 has steadily increased from less than 38 years old in 1980 to more than 45 years old in 2013. In 1980, 5.6% of grant funding went to investigators who were younger than 36, but by 2012, this had dropped to just 1.3%. Principal investigators over age 65 are awarded more than twice as many R01s as those under age 36.

It has become increasingly challenging for young scientists to secure necessary funds to advance their careers in research. In turn, this puts future generations of biomedical researchers in jeopardy because more scientists are becoming disheartened and exploring other career paths. It also disrupts the emergence of scientific breakthroughs from bright young minds with untapped potential.

There are many reasons why young investigators may be losing out on the fight for NIH funding. For one, some are spending more time in post-doctoral programs training and it is taking longer for them to secure faculty positions. There may also be unintentional bias from review committees to select more established investigators who have a proven track record of success rather than taking a risk on unknown scientists. Funding has been reduced over the years making the competition fiercer and the awarding of grants increasingly selective. This also means that universities must shoulder a larger portion of the costs associated with supporting research endeavors.

The Diabetes Research Connection (DRC) is reversing this trend by funding early-career scientists who then leverage funding from DRC to seek additional funding from larger foundations and NIH.

 

DRC is supporting the next generation by directing its fundraising toward early-career scientists. It recognizes that mainstream funding is highly competitive, and, as the above research has shown, is less frequently awarded to young researchers. Through DRC, scientists receive up to $70,000 from donors for their research projects, which can be enough to give them a strong foundation to conduct novel research related to type 1 diabetes. To learn more about current projects and support these efforts, visit http://diabetesresearchconnection.org.

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The Growing Cost of Type 1 Diabetes Management

For individuals with type 1 diabetes (T1D), insulin is a life-saver. Literally. Without it, their body can go into a state of diabetic ketoacidosis where blood sugar becomes so high that the body shuts down. It can be fatal if not treated immediately. Since the pancreas does not produce enough (or in some cases any) insulin on its own, people with T1D rely on insulin daily to keep their blood sugar in check. However, the cost of this life-saving hormone has continued to increase over years, and for some, it has become unaffordable, even with insurance.
A vial of insulin can cost around $250 without insurance or other financial assistance. It is not unusual for someone with T1D to use between two and four vials every month. That means they could be paying $500 to $1,000 for a medication that is critical to their survival. Even with insurance, deductibles can be thousands of dollars. This means they must pay this money up front – in addition to monthly premiums – before insurance kicks in to help offset costs. For some, this is simply not feasible. Despite having a solid job, the cost can be too much on top of other living expenses such as rent, utilities, and food.
Unfortunately, this means that some people with type 1 diabetes have resorted to rationing their insulin supply in an effort to make it last longer. They administer less insulin than their body actually needs to keep their blood sugar within a desirable range. This can quickly spiral out of control and lead to complications such as diabetic ketoacidosis. It is a dangerous decision, but if they cannot afford more insulin, they may feel it is better than going without.
Many people are fighting for improved regulations regarding pricing for insulin as well as insurance so that people do not have to choose between paying for insulin versus other bills, or deciding how to make the insulin they do have last until they can afford more. There are organizations that can help individuals with diabetes to find financial assistance to help with the cost of insulin and other diabetes supplies, and sometimes they may be able to get insulin for free depending on the situation. Not everyone is aware of these options and resources, however, so advocacy is so important.
Type 1 diabetes is a manageable condition, but people must have access to the necessary resources in order to survive. While treatment options have improved over the years, the cost is still an issue.
The Diabetes Research Connection (DRC) strives to support peer-reviewed, novel research studies regarding type 1 diabetes treatment and management. As scientists gain a greater understanding of this disease, it may help to make future care more affordable and eventually lead to a cure. To learn more about the Diabetes Research Connection and support current projects, visit http://diabetesresearchconnection.org.

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Increasing Polyclonal IgMs May Help Prevent or Reverse T1D

A common strategy used by researchers in treating type 1 diabetes (T1D) is to destroy or deactivate immune cells that mistakenly attack insulin-producing beta cells. There have been many variations on this approach over the years, but effectiveness has been limited. Typically, these autoreactive cells reemerge. However, tackled this issue from a different angle instead of looking at how to increase certain protective cells.

Researchers, including Daniel Moore who works with the Diabetes Research Connection, found that IgMs have immunoregulatory properties that help to limit inflammatory responses and decrease autoreactive B lymphocytes. Islet-reactive B lymphocytes have been found to produce anti-islet antibodies linked to the development of stage 1 T1D. IgM may also help to stimulate the production of regulatory T cells.

When administered in non-obese diabetic (NOD) mice, purified IgM was able to prevent the development of diabetes and increase regulatory T cells. However, IgM that was taken from pre-diabetic mice was not as effective. IgM obtained from Swiss Webster donor mice (recognized as healthy, not pre-diabetic, mice) was highly effective in reversing hyperglycemia and preventing the onset of diabetes. The researchers also used human IgM from healthy donors and found similar results.

The study shows the potential effectiveness of healthy donor IgMs in promoting normal immune homeostasis, preventing diabetes occurrence, and reversing new-onset diabetes. While immunoglobulin therapy is not a new concept, it usually contains low levels of IgM, whereas this study focused on higher levels of purified IgM. More research is necessary to further explore the potential of donor polyclonal IgM for the prevention and treatment of type 1 diabetes.

Daniel Moore, a senior author on the study, is a scientist associated with the Diabetes Research Connection (DRC). The DRC is committed to funding novel, peer-reviewed research focused on preventing and curing T1D as well as improving quality of life for those with the disease. It has played a role in supporting dozens of projects. To learn more about current studies, visit http://diabetesresearchconnection.org.

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