Is there really a cure in sight for Type 1 Diabetes?

You may think of Type 1 diabetes as a disease that occurs acutely, with the most common symptoms of polydipsia, polyuria and polyphagia appearing seemingly without warning. However, we now know that this autoimmune disease,in which the body attacks its own insulin producing pancreatic beta cells, begins to manifest from three to five years before the onset of any physical symptoms. Thanks to work done in large part by TrialNet, five antibodies have been identified that can signal impending Type 1 diabetes. In fact, two of the five are now considered early stage Type 1 diabetes. Screening typically starts with relatives of those with known Type 1 diabetes, as they are 15 times more likely to develop the disease. And at-home screening kits are now available.

The Juvenile Diabetes Research Foundation (JDRF) is also a major player at the forefront of diabetes research, and their sponsored research falls into two main buckets:

• Research to reduce the burden of diabetes – such as the artificial pancreas
• Research towards a cure, which also tends to fall into two main areas:
  • Prevention of Type 1 diabetes
  • Reversal of the disease once it has manifested

Delayed onset and prevention of Type 1 Diabetes

Prevention of Type 1 diabetes focuses on blunting the autoimmune response that causes the attack of the beta cells. A recently published human trial has reported a two-year delay in the onset of Type 1 diabetes with the use of the drug teplizumab.¹ And, one promising type of vaccine research is focusing on introducing a protein into the blood that induces friendly immune cells that can thwart the destructive antibodies that attack the pancreatic beta cells.

Curing Type 1 Diabetes

An actual cure for diabetes is currently thought to be most likely in one of three ways:

• Eliminating the autoimmune response to begin with. Research has pointed to the beta cell proteins which become self-antigens and is looking for ways to eliminate the progression to development of antibodies and ultimately avoid beta cell destruction.
• Replacement of destroyed pancreatic beta cells.² This therapy focuses on transplant of beta cells back into the person living with diabetes. Perhaps the most promisingly source is from embryonic stem cells. Researchers are also studying ways to encapsulate these new beta cells and prevent them from autoimmune attack.
• Regeneration of pancreatic beta cells. Gene therapy is a potential means of enhancing the body’s natural ability to regenerate beta cells. The gene therapy involves delivering cellular factors that are known to enhance beta cell growth and regeneration to the pancreas.³

More information

And, there are many other types of research going on – including the role of the gut microbiome.⁴ If you like to keep abreast, the links below will take you to organizations and site for review.  These organizations and many others also provide a way to support research for Type 1 diabetes.

JDRF

ADA

NIDDK

T1D Exchange Glu

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References

1. Herold KC, Bundy BN, Long A et al: An anti-CD3 antibody, Teplizumab, in relatives at risk for Type 1 diabetes. NEJM 381: 603-613, 2019.
2. Keiffer TJ, Woltjen D, Osafune K et al: Beta cell replacement strategies for diabetes. J Diabetes Investig. 9(3): 457-463, 2018.
3. Xiao X, Ping G, Shiota C et al: Endogenous reprogramming of alpha cells into beta cells induced by viral gene therapy reverses autoimmune diabetes. Stem Cell 22(11): 78-90, 2018.
4. Aw W, Fukuda S: Understanding the role of the gut ecosystem in diabetes. J Diabetes Investig. 9(1): 5-12, 2019.