By Kat McGregor
A recent study has shown that type 1 diabetes is likely to be two separate conditions, or endotypes, dependent on their age at diagnosis. This breakthrough may revolutionise treatment of type 1 diabetes, tailoring treatment dependent on the age of the child.
Current estimates from Diabetes UK say that by 2025 an astonishing 4million Brits will be diagnosed with diabetes. Type 1 diabetes is the rarer of the two known types, accounting for only 10% of the cases diagnosed. Diabetes is an incredibly serious disease and, if left untreated, can lead to blindness, kidney failure, heart disease and stroke. Type 1 diabetes develops if there is a problem with the body’s ability to produce the hormone insulin. Low amounts of circulating insulin in the blood mean that there is a high amount of glucose circulating (hyperglycaemia) as the glucose is no longer able to enter cells to be used as fuel.
In March 2020, a study published in Diabetologia evidenced that the regions of the pancreas that produce insulin (the islets of langerhans) were distinctly different in children diagnosed with diabetes 7 years and younger, compared to those diagnosed 13 years or older.
This study has shown that in children diagnosed aged 7 and under, there is aggressive destruction of insulin producing cells, known as beta cells, by their own immune system. In the same group, the precursor hormone to insulin (proinsulin) is not processed properly by the beta cells and is released with insulin.
In contrast, children diagnosed aged 13 and over still have autoimmune destruction of pancreatic cells but maintain more of their insulin producing beta cells. There is also very little co-localisation of proinsulin and insulin as there appears to be near normal processing of the precursor hormone.
“We propose that these may represent disease endotypes and suggest that they are defined as type 1 diabetes endotype 1 (T1DE1) and type 1 diabetes endotype 2 (T1DE2).” Noel Morgan, University of Exeter
The results from this study are promising. Researches are optimistic that the age of diagnosis might be a clue as to the endotype of disease which opens the door of possibilities to tailored diagnostic tests and eventually treatments.
Dr Elizabeth Robertson, Director of Research at Diabetes UK:
“Being able to make the distinction between different subtypes of type 1 diabetes is an exciting new development and we’re proud to have supported this landmark research. We now need to make sure this discovery is used to help design trials and tailor future treatments, so we can move closer to stopping and preventing type 1 diabetes.”
“Today’s news brings us one step closer to achieving that”
Read the full paper here: https://link.springer.com/article/10.1007/s00125-020-05115-6