How to Detect Type 1 Years in Advance

There has been a push to catch Type 1 diabetes before diabetic ketoacidosis sets in, but some researchers wonder if we should be catching Type 1 years before symptoms appear.

That was the focus of a recent JDRF webinar led by the organization’s chief scientific officer, Dr. Richard Insel. Dr. Insel shared the findings of a large study published in Diabetes Care which found that biomarkers for Type 1 diabetes often could be found years before those with Type 1 showed symptoms.

“For childhood onset Type 1 diabetes, the autoimmune process…begins very early in life,” he said.

The international study screened some 400,000 children for having a genetic disposition towards developing Type 1 diabetes. The study tracked children for 15 years, and 650 of the study participants eventually developed Type 1.

By tracking the children for so long, researchers were able to find evidence that those who developed Type 1 had shown physiological signs long before they showed symptoms – including the development of antibodies against beta cells. One study of Finnish children with Type 1 found that 95% of those who developed Type 1 by fifteen years of age showed signs of these antibodies by age 5, for example. It’s also important for researchers to get good at detecting these precursor biomarkers because beta cell destruction progresses more quickly in children with Type 1 than adults with Type 1, so any intervention has to happen as soon as possible in the process.

“If we’re going to prevent Type 1 diabetes, we’re going to have to intervene very early,” Insel said.

Detecting early biomarkers of Type 1 diabetes helps researchers think of how to formulate early intervention treatments, including giving high doses of oral insulin to children showing physiological signs of the condition. Such early intervention is already being tried in some studies, but it’s too early to tell if this will lead to better glucose control or fewer complications in the long run, he said.

Unfortunately, there will be increased demand for such interventions, as research shows that rates of Type 1 diagnosis are climbing. A recent large-scale study, the SEARCH study, found that there will be a threefold increase of Type 1 diabetes diagnoses among all children, with a more than sixfold increase in Type 1 diabetes among Hispanic youth, according to Insel.

The increase “reflects some environmental issues that we don’t really understand,” he said.

The study was a joint effort involving many major diabetes organizations, including the American Diabetes Association, the Endocrine Society, and the Helmsley Charitable Trust.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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