Can You Delay the Onset of Type 1 Diabetes?
With diabetes being so prevalent today, there is increasing emphasis placed on finding ways to prevent or delay the onset of diabetes. This article is specifically about the less common form of diabetes that occurs in young children, adolescents and young adults called type 1 diabetes (T1D).
According to the World Diabetes Atlas in 2021 there were about 150,000 young people diagnosed with T1D globally and about 1.2 million people living with T1D around the world. In Australia there are about 3,000 children diagnosed with T1D every year and 130,000 children and adults currently living with T1D.
Currently, people living with Stage 1 Type 1 diabetes are dependent on a lifetime of insulin injections to control their blood sugar levels and live as normal and long a life as possible without complications. The search for the underlying immunological cause(s) of T1D over the last 40 years has progressed enormously with an improved understanding of the underlying genetic and environmental triggers that lead to the autoimmune attack against the insulin-producing cells (the beta cells) in the pancreas.
With this understanding, we now know that children at high risk of developing T1D can be identified before they have any symptoms of diabetes and before they require insulin therapy. Genetically at-risk individuals with what is known as HLA-DR 3 or DR4 gene signatures confers 50% of the genetic risk of developing T1D. These genetically at-risk individuals for developing T1D can now be screened by detecting specific auto-antibodies in their blood. These auto-antibodies are produced by the individual’s immune system as a sign of the immune-attack against the pancreatic insulin-producing beta cells.
If you have two or more of the 4 commonly tested auto-antibodies there is a 70% risk of developing T1D in the next 10 years, while if you have all 4 auto-antibodies present the risk is 100%! These advances in the understanding of the autoimmune process in T1D has provided the foundation for key clinical studies aim at preventing the onset of T1D that have been published in the last 3 years.
Now, let’s delve into some of the latest research and findings regarding the possibility of delaying the onset of T1D, with some recent ground-breaking discoveries that offer exciting hope for people who are at high risk of developing T1D.
What is Type 1 diabetes (T1D)?
This is a chronic condition where the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. Insulin is a hormone vital for regulating blood sugar (glucose). Without enough insulin, the body cannot properly convert glucose from food into energy. Elevated blood sugar levels are the result which can lead to severe illness including often at diagnosis diabetes ketoacidosis and long-term complications affecting the eyes, heart, kidneys and nervous system.
Symptoms of Type 1 diabetes include what has been termed the 4Ts
- Thirst – drinking copious amounts of water
- Toilet - Frequent urination, including bed wetting
- Thinner - Unusual weight loss
- Tired - Lethargy and fatigue
Other symptoms that can occur include
- Extreme hunger
- Irritability and mood swings
- Blurred vision
- Frequent infections, especially fungal infections
Contributing factors to diabetes
Although the exact environmental triggers for Type 1 diabetes remain unclear, there are some known probably contributing factors and these include:
- Larger birth weight and infant weight gain and being overweight
- Virus infections – including enterovirus and possibly rotavirus infections
- Eating an unhealthy diet (that lacked enough fruit, vegetables, fibre and healthy protein and fats) and consuming highly processed foods can cause unhealthy gut bacteria or gut microbiome and lead to excessive weight gain
- A family history of Type 1 diabetes, with ~ 5-10% risk depending if the affected relative is your sibling (8%),Father (5%), or Mother (3%)
Figure 1 from Quinn LM, Wong FS, Narendran P. Environmental Determinants of Type 1 Diabetes: From Association to Proving Causality
An overview of recent diabetes studies and trials
Much of the recent and ongoing diabetes research has focused on determining who is most at risk of developing Type 1 diabetes. When you can identify those who are most at risk, then administering measures to possibly prevent, or at least delay the onset of the disease by years. This is good news for individuals who fall into this category.
The onset of T1D symptoms usually occurs in infants and children or early adulthood. Studies estimate that the life expectancy of people with Type 1 diabetes is reduced by up to 13 years. The longer a person has to live with T1D, the greater the impact on life expectancy. This is why it’s so crucial to delay the onset of the disease. Solutions that delay Type 1 diabetes symptoms will lead to an increase in life expectancy.
Janssen Pharmaceuticals recently teamed up with JDRF, a leading research advocacy organisation, with the goal of taking on the challenge of identifying the root cause of Type 1 diabetes. Achieving this, medical professionals can then intercept its progression before T1D symptoms manifest. According to JDRF, understanding what triggers Type 1 diabetes to begin with could ultimately lead to the prevention of the disease or a cure for people who already have T1D.
Advancements in screening for T1D potential have been made, due to research and studies like these. With a simple blood test that spots signs called autoantibodies, people who are highly likely to develop T1D can be readily identified. A simple and non-invasive screening process such as this then allows medical professionals to administer a solution to either prevent the disease or slow the onset of Type 1 diabetes.
The Walter and Eliza Hall Institute of Medical Research and The Royal Melbourne Hospital teamed up to conduct a five year international trial that involved 76 children and young adults in the high-risk category. This resulted in a significant discovery. Immunotherapy, which we will cover in more detail in the next section can delay the onset of Type 1 diabetes.
It’s important to note that there are always challenges and limitations when it comes to diabetes research and other forms of medical research. Trials, studies and research are always ongoing and it’s a field that is constantly evolving. The good news is that every year we’re getting closer to a cure for Type 1 diabetes.
Potential prevention strategies
So, what are some of the current strategies that may prevent or at least delay the onset of T1D?
Population screening for T1D with auto-antibody testing in infants and primary school children around Australia.
In October 2023 the first Australian national T1D screening pilot study was launched by researchers from the Charles Perkins Centre at The University of Sydney with nationwide collaborators and with support from the JDRF – see link below for further information as you may possibly enter your own child into this screening program. See https://www.kidsdiabetesscreen.com.au/ and also through Trial Net https://type1screen.org/
Once children with 2 or more antibodies are identified it may be possible to enter such a child into prevention studies available around Australia – see TRIAL-Net for further information at https://www.trialnet.org/. and the JDRF website https://jdrf.org.au/clinical-trials/.
Immunotherapy
As a result of the studies and conclusions of the Walter and Eliza Hall Institute of Medical Research and The Royal Melbourne Hospital trial, the FDA recently approved a new treatment called Teplizumab, with the brand name Tzield.
Administered intravenously, this is an injection given to patients who are most at risk of developing Type 1 diabetes. Trials of the treatment have demonstrated that the onset of T1D can be delayed by up to two years, possibly even longer in some individuals. While two years may not sound like a significant figure, research is ongoing. Expect that figure to increase as treatment options are further developed and refined.
Within the last few months two other ground-breaking studies ( one from Australia) in children with newly diagnosed T1D have shown the benefit of Teplizumab and another immunotherapy agent called Baricitinib, that is used in the treatment of rheumatoid arthritis, to help preserve the pancreas’ remaining beta cell insulin secretion. This suggests these agents could possibly prolong the “honeymoon” phase of the early phase of T1D. These encouraging results could mean less insulin requirements and potentially better diabetes control for the treated children. (see four references below)
Lifestyle changes
Lifestyle changes can help prevent or slow down the onset of T1D. If you are overweight, it’s vital you make a concerted effort to move to a healthier weight and body mass index (BMI) through a combination of a healthier diet and regular exercise. Being overweight or obese is a major contributor to developing diabetes whether it is T1D or Type 2 diabetes (T2D).
Not only will exercise help you prevent excess weight gain, but it also helps lower your blood sugar levels, along with boosting your body’s sensitivity to insulin. A combination of aerobic and resistance training is best and even when you’re not actively engaged in exercise, get up and walk around, do some stretching and move the body. Avoid being sedentary for long periods.
Dietary changes
Changes to your diet are also vital in the fight against Type 1 diabetes. Fibre-rich plant foods are not only healthy, but also help slow down T1D onset. Focus on fruits, leafy vegetables, beans, as well as foods containing whole grains such as oats and quinoa. Food high in fibre slows the absorption of sugar and also lowers blood sugar levels.
Consume healthy fats such as olive oil and sunflower oil, fatty fish like salmon and tuna, and eat nuts regularly. These all contain good fats (unsaturated fats). Limit saturated fats (bad fats), like those found in dairy products.
Things you can do
If you have concerns about Type 1 diabetes, the first thing you should do is discover if you’re in the high-risk category. Consult with your doctor for screening. Following the screening process, if you are at risk, book regular medical check-ups and monitor the development of any typical symptoms.
As discussed above, adopt a healthy lifestyle with a healthy diet and regular exercise.
Read up on T1D to gain a better understanding of the condition, its prevention and management. Having a deeper understanding will lead to more peace of mind.
We’re here to help you combat Type 1 diabetes
At Childhood Obesity Prevention, we are dedicated to the fight to help prevent or slow down the onset of both Type 1 and Type 2 diabetes. We encourage you to stay informed about this prevalent disease and to consult us for personalised advice if you have concerns.
For more detailed information on Type 1 diabetes, click through to our dedicated page that delves into T1D, how it differs from Type 2, causes, treatment options and much more.
Type 1 diabetes is preventable, manageable and, hopefully in the future, curable.