Type 1 Diabetes

Diabetes distress

Diabetes distress is a term used to describe the emotional and psychological challenges of living with diabetes. It can include feelings of anxiety, depression, stress, and burnout. Diabetes distress can be caused by a number of factors, such as the demands of managing blood sugar levels, the risk of complications, and the social stigma associated with diabetes.

People with both type 1 and type 2 diabetes can experience diabetes distress. However, the prevalence of diabetes distress is higher in people with type 1 diabetes. This is likely due to the fact that people with type 1 diabetes need to take insulin every day and are at higher risk of developing complications.

Treatment for diabetes distress

There are a number of treatments available for diabetes distress, including:

• Education and support: Education and support programs can help people with diabetes to learn more about their condition and develop coping skills.
• Individual therapy: Individual therapy can help people with diabetes to identify and address the underlying causes of their diabetes distress.
• Group therapy: Group therapy can provide people with diabetes with the opportunity to connect with others who are facing similar challenges and learn from each other's experiences.
• Medication: In some cases, medication may be prescribed to treat depression or anxiety associated with diabetes distress.

If you are experiencing diabetes distress, it is important to talk to your doctor or a mental health professional. There is help available, and you don't have to go through this alone.

Type 1 diabetes (T1D) is a chronic autoimmune disease in which the body's own immune system attacks and destroys the beta cells in the pancreas. Beta cells are responsible for producing insulin, a hormone that helps the body's cells use glucose for energy. Without insulin, glucose builds up in the bloodstream, leading to hyperglycemia (high blood sugar).

The exact cause of T1D is unknown, but it is thought to be caused by a combination of genetic and environmental factors. People with T1D have a genetic predisposition to the disease, meaning they have certain genes that make them more likely to develop it. However, the presence of these genes does not guarantee that someone will develop T1D. An environmental trigger, such as a viral infection or exposure to certain chemicals, is also needed to initiate the autoimmune process.

Once the autoimmune process is underway, the body produces autoantibodies, which are antibodies that attack the body's own tissues. In T1D, the autoantibodies attack the beta cells in the pancreas. This attack can damage or destroy the beta cells, leading to insulin deficiency and hyperglycemia.

The immunological causes of T1D are complex and not fully understood. However, it is thought that the following mechanisms play a role in the disease:

• T cell activation: T cells are a type of white blood cell that plays a central role in the immune system. In T1D, autoreactive T cells are activated and become cytotoxic, meaning they can kill beta cells.
• Cytokine production: Cytokines are signaling molecules that regulate the immune system. In T1D, pro-inflammatory cytokines are produced in excess, which leads to inflammation and beta cell death.
• B cell activation: B cells are a type of white blood cell that produces antibodies. In T1D, autoreactive B cells are activated and produce autoantibodies that attack beta cells.

Current research on the immunological causes of T1D is focused on identifying the environmental triggers that initiate the autoimmune process and developing new therapies to prevent or delay disease onset.

It is important to note that T1D is not contagious and cannot be prevented. However, there are treatments available to help manage the condition and improve quality of life.

A number of new immunological therapies are currently being developed for autoimmune type 1 diabetes (T1D). These therapies aim to either prevent or delay disease onset, or to preserve beta cell function and improve insulin production in people with established T1D.

Some of the most promising new immunological therapies for T1D include:

• Teplizumab: Teplizumab is a monoclonal antibody that targets CD3, a protein found on the surface of T cells. Teplizumab has been shown to delay the onset of phase 3 T1D in high-risk individuals. It was approved in late 2022 by the FDA in USA as a preventive therapy for T1D in children 8 years and above at high genetic risk of T1D in phase 2 of the autoimmune process in T1D. It is not available outside the USA presently.
  • References:
    • Ana Luisa Perdigoto, P. P.-H. (2019). Treatment of type 1 diabetes with Teplizumab: clinical and immunological follow-up after 7 years from diagnosis. Diabetologia, 62, 655-664.
    • Herold KC et al. An Anti-CD3 Antibody, Teplizumab, in relatives at risk. New Eng J Med. 2019: 381(7),603-613.
    • Besser REJ, Bell KJ, Couper JJ et al. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatric Diabetes 2022;1-13.
• Otelixizumab: Otelixizumab is another monoclonal antibody that targets CD3. It is currently in Phase 3 clinical trials for the prevention of T1D in high-risk individuals.
• Treg cell therapy: Treg cells are a type of T cell that suppresses the immune system. Treg cell therapy involves expanding and reinfusing Treg cells into people with T1D. Treg cell therapy has shown promise in early clinical trials, and it is currently being investigated as a potential treatment for established T1D.
• Stem cell therapy: Stem cell therapy involves transplanting stem cells into the pancreas in order to generate new beta cells. Stem cell therapy is still in the early stages of development for T1D, but it has the potential to be a curative therapy.

In addition to these new therapies, there are a number of other immunological therapies that are currently being investigated for T1D, including:

• Immune checkpoint inhibitors: Immune checkpoint inhibitors are drugs that block the activity of immune checkpoints, which are molecules that keep the immune system from overreacting. Immune checkpoint inhibitors have been shown to be effective in treating other autoimmune diseases, and they are currently being investigated for the treatment of T1D.
• Antigen-specific immunotherapy: Antigen-specific immunotherapy involves exposing the immune system to specific antigens in order to induce tolerance. Antigen-specific immunotherapy is still in the early stages of development for T1D, but it has the potential to be a highly targeted and effective therapy.

It is important to note that all of these new immunological therapies are still under investigation, and it is not yet clear how effective they will be in the long term. However, the development of these new therapies offers hope for people with T1D, and it is possible that they could one day lead to a cure for the disease.

Here are links to the JDRF research website and TrialNet for diabetes research:

• JDRF research website
• TrialNet for diabetes research