DRC & Research News

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Sleep Disturbances with Type 1 Diabetes

Sleep Disturbances Common with T1D

Type 1 diabetes is a disease that must be monitored around the clock. When children are awake, it is easier to tell when blood sugar may be spiking too high or dropping too low. At night, this is more challenging, and it is essential to continue testing blood sugar levels to stay within the target range and administer insulin as necessary.

Children typically rely on their parents to manage their diabetes and monitor blood sugar, whether done manually or through a continuous glucose monitor (CGM). A recent study found that children who use a CGM often sleep better at night, but it is their parents who have more disturbances in their sleep due to reacting to CGM data.

As part of a larger study, researchers evaluated the sleep quality of 46 parents of children with type 1 diabetes. The children were between the ages of 2 and 5, and some used CGMs while others did not. Parents reported on the time their children went to bed, woke up, and how long they slept. The average was 10.4 hours per night. Also, all 11 families who used CGMs wore accelerometers that tracked their sleep patterns for a minimum of four nights. The accelerometer showed an average of 9.8 hours of sleep per night for children.

According to the study, “Among the full cohort, 63% of parents reported checking their child’s blood glucose levels at least a few nights per week. Parents of children using CGMs reported a higher frequency of nighttime blood glucose monitoring compared with parents of children without a CGM.”

The percentage of parents who experienced sleep disturbances concerning blood glucose monitoring was noticeably higher than the percentage of children, at 78.3% and 17% respectively. Parents of children with CGMs reported higher levels of sleep disturbance, especially when the child’s diabetes was more difficult to manage. Additional research with a larger group of participants across a longer period of time is necessary to better understand the impact of diabetes management on sleep for parents and children.

It is important for physicians to keep in mind not just the impact a CGM or other device could have on the child’s health and quality of life, but also on the parent. Parents benefit from having proper support systems in place and information to help them cope with the challenges of managing their child’s type 1 diabetes.

Diabetes Research Connection, though not involved in this study, is committed to supporting early-career scientists focused on studying type 1 diabetes and ways to improve prevention, treatment, and quality of life, as well as one day finding a cure. One hundred percent of donations go directly to the scientists for their research. To learn more about current projects and how to help, visit https://diabetesresearchconnection.org.

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Reduced Out-of-Pocket Insulin Costs for Seniors Through Medicare

Out-of-Pocket Insulin Costs for Seniors

The cost of buying insulin can quickly add up, but this medication is life-sustaining for individuals with type 1 diabetes. Many seniors are on a fixed income, and some may struggle to afford the out-of-pocket costs for insulin, which can lead to rationing their supply. This can be incredibly dangerous to their health.

The Centers for Medicare & Medicaid Services (CMS) recently announced that it would implement measures to help curb these costs for seniors. Many Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage will now be offering lower insulin costs to seniors, capping the copay at $35 for a month’s supply. This is part of the new Part D Senior Savings Model and will cover “both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.”

Insulin manufacturers and Part D sponsors are working together to offer this market-based solution that enables them to provide deeper discounts to seniors and fixed, predictable copays in the coverage gap. According to CMS, “beneficiaries who use insulin and join a plan participating in the model could see an average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model.”

Seniors will be able to go on to the CMS website and compare their prescription drug plan options to find a participating sponsor and plan that fits their needs. Enrollment would begin in the fall for coverage starting on January 1, 2021. There have also been numerous actions that have been taken in response to COVID-19 to support individuals with type 1 diabetes in accessing and affording insulin.

It is encouraging to see drug manufacturers and insurance companies making changes to improve access and affordability of life-sustaining medications such as insulin. Diabetes Research Connection (DRC) will continue to stay abreast of these trends and how they impact diabetes management. DRC provides critical funding for researchers focused on type 1 diabetes to find a cure and improve prevention and treatment options as well as the quality of life. To learn more, visit https://diabetesresearchconnection.org.

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Where is the Diabetes Research Connection Heading in 2020?

Our vision is to support innovative scientific inquiry until diabetes is eliminated. Since 2015, we have funded 24 innovative, peer-reviewed type 1 diabetes (T1D) projects and distributed over $1M directly to early-career scientists, building a pipeline of talented T1D researchers. 100% of funds designated for research go directly to the scientists’ lab and we are committed to continuing this in 2020.

Our main initiative in 2020, and the next decade, is to establish a foundation of sustainable funding. Two new ways we hope to accomplish it are:

  1. Blue Circle Leaders: Our current Blue Circle Leader Community includes 10 families who have pledged consistent support of our mission and vision. There are varying levels of partnership and all help us build a pipeline of new T1D researchers. As a Blue Circle Leader, you will have access to exclusive opportunities and resources. Read more about becoming a Blue Circle Leader here.
  2. Name a Research Project: Name an entire Research Project after your family, foundation or loved one affected by T1D. Funding an entire grant gives you exclusive access to the researcher for individual updates about the progress of their project and recognition in all published materials.

For a summary of the accomplishments in 2019, click here. We believe it takes a community to connect for a cure and together we make the difference!

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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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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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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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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. Learn more about current studies and how to support these efforts by visiting 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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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.”

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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