Symposium hears of latest developments in predicting type 1 diabetes risk

by Barbara Hewitt on July 9, 2013

Symposium hears of latest developments in predicting type 1 diabetes risk

Symposium hears of latest developments in predicting type 1 diabetes risk

In a major step toward determining when type 1 diabetes begins to develop, researchers have created tools for accurately predicting who is at highest risk of the condition, opening possibilities for earlier intervention. There is also ongoing research to identify the triggers for type 1 diabetes, which, like type 2 diabetes, has been increasing globally in recent decades. But unlike type 2, which is associated with the global rise in obesity and an aging population, the causes for the increase in type 1 remain unclear.

In addition, finding out just how much type 1 is increasing overall has not been easy for researchers, who have run into hurdles collecting data, particularly in low income countries, scientists were told at the recent American Diabetes Association scientific symposium. The symposium also drew attention to the difficulty people in low income countries often have accessing insulin and other diabetes supplies.

Though researchers are still searching for answers for how to prevent type 1 diabetes, great strides have been made recently in predicting who is most likely to develop the disease. This allows researchers to identify type 1 at the earliest stages of development and potentially intervene to preserve beta cell function at a much earlier stage and ultimately prevent onset of symptomatic diabetes. Analysing the database from the Diabetes Prevention Trial of Type 1 Diabetes (DPT1), Dr Jay Sosenko, Professor of Medicine and Epidemiology at the University of Miami, identified the variables that were most predictive of who would develop symptomatic type 1 diabetes and used them to create a risk score.

Quote from : “Adapting an approach they were already working on, Steinman and colleagues inserted a piece of DNA from the proinsulin gene that they suspected would cause the immune system to launch an anti-inflammatory signal only to the CD8 cells targeting proinsulin. In other words, they designed a vaccine that makes the immune system attack the bit of itself that is attacking the beta cells.”

These variables included BMI, age, fasting C-peptide levels, a measure of overall C-peptide production and a measure of overall glucose. The C-peptide and glucose measurements were obtained from oral glucose tolerance tests. Sosenko then applied the DPT1 Risk Score (DPTRS) to data from another study, known as the TrialNet Natural History Study, also known as the Pathway to Prevention Study. The findings showed that the DPTRS was highly predictive of who would ultimately be diagnosed with symptomatic type 1 diabetes in TrialNet. ‘The DPTRS can identify even those who have normal glucose tolerance but who are nonetheless at risk, in part because it takes age into account,’ said Dr Sosenko.

He found that once the DPTRS passed a certain threshold, individuals were highly likely to develop symptomatic type 1 diabetes. ‘So, a very high DPTRS value could possibly mean that someone has diabetes. The data suggest that the DPTRS, or a modification of it, could potentially provide an additional means for diagnosing type 1 diabetes,’ he explained.

A second study, The Environmental Determinants of Diabetes in the Young (TEDDY), is looking at population based predictions of type 1 diabetes and potential triggers for the disease. ‘Most new cases of type 1 are not in first degree relatives of those who have already been diagnosed, but rather sporadic cases from the population at large,’ said lead researcher William Hagopian, MD, PhD, Scientific Director of Pacific Northwest Diabetes Research Institute in Seattle, and Clinical Associate Professor of Medicine at the University of Washington in Seattle.

The TEDDY study screened children at birth to identify those with the highest genetic risk of developing type 1 and is following those children for development of islet antibodies and diabetes. The study has 1,300 participants at six medical centres in Sweden, Finland, Germany, Florida, Colorado and Washington, for a total of 8,600 participants. The researchers estimate that 400 of them will ultimately develop type 1 diabetes. So far, 150 participants have been diagnosed with type 1 diabetes.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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