Researchers know that there are significant differences between type 1 diabetes (T1D) and type 2 diabetes (T2D), but now they are digging a little deeper. When it comes to T1D, the disease may not affect everyone in the same way. According to a recent study, there may be more than one endotype, and a major differentiator could be age of diagnosis.

The study looked at a small sample of 19 children diagnosed with T1D within the past two years and compared age of diagnosis against amount of beta cell destruction and levels of proinsulin and C-peptides. They also compared these ratios in a group of 171 adults with T1D based on their age of diagnosis. Their results showed that children who were diagnosed before the age of 7 had much higher levels of proinsulin-insulin co-localization than those diagnosed after age 13. Individuals between ages 7 and 13 were divided and fell into one group or the other.

The researchers also compared results against CD20Hi and CD20Lo immune profile designations for each participant. Children age 7 or younger tended to be CD20Hi, while those age 13 or older were CD20Lo, and the children in between were aligned with their respective groups based on whether they were CD20Hi or CD20Lo.

These differences in proinsulin and C-peptide concentrations demonstrate a distinction in how individuals are impacted by T1D, leading to at least two separate endotypes. Understanding whether an individual has T1D endotype 1 (T1DE1) or T1D endotype 2 (T1DE2) could enable more targeted and effective treatment of the disease based on how each group responds. Individuals with T1DE1 are identified as having higher levels of beta cell loss, therefore may have more difficulty regulating blood glucose. Those with T1DE2 may retain more beta cells, and determining ways to activate and protect these cells could support improved natural insulin production.

Recognizing that T1D affects people differently is a step in the right direction toward more personalized medicine and targeted therapies. Therapeutic trials could be aimed at groups depending on age of diagnosis and specific endotype in the future as larger studies are conducted to determine the significance of these findings.

Diabetes Research Connection (DRC) is committed to supporting advances in research around type 1 diabetes and provides early-career scientists with critical funding for their studies. Research is focused on preventing and curing type 1 diabetes, minimizing complications, and improving quality of life for those living with the disease. Learn more and support these efforts by visiting http://localhost/drc.