Discovery of Type 1 subtypes 

Researchers have found that young children diagnosed with Type 1 diabetes appear to have a different form (or ‘subtype’) of the condition to those diagnosed as older children and adults. This discovery could lead to new and more tailored treatments.  

The JDRF-funded research found that children diagnosed under the age of seven have beta cells that don’t process insulin properly. The researchers, led by Dr Pia Leete at the University of Exeter, also found that the immune system rapidly destroyed most of these cells. In contrast, people who were older than 13 when diagnosed had beta cells that could process insulin normally. While they lost most of their beta cells, these people often continued to make small amounts of their own insulin after diagnosis. 

Children who are diagnosed between seven and 13 could fall into either group, and the researchers are working on ways to distinguish between them, which could make a big difference to the way scientists develop treatments to cure or prevent Type 1. 

Subtype differences 

 The team made the discovery when studying pancreas samples from people newly diagnosed with Type 1 diabetes, some of which came from the JDRF-funded Network for Pancreatic Organ donors with Diabetes (nPOD).

In samples from children who were younger than seven at diagnosis, the researchers found fewer beta cells capable of producing insulin, and more immune cells invading the pancreas. These samples also showed that the beta cells weren’t functioning correctly, releasing both insulin and another molecule called proinsulin, which is broken down by beta cells when they make insulin. Usually, beta cells don’t release both insulin and proinsulin simultaneously. 

Pancreas samples from people diagnosed older than 13 did not show signs of proinsulin being released alongside insulin. Instead, these cells were producing insulin normally, although only in tiny amounts. 

This suggests that testing for insulin and proinsulin could be a way to check which of the subtypes of Type 1 diabetes a person has when diagnosed between seven and 13 years old, and determine different treatments, eg the two groups may respond differently to different immunotherapies. Also, the younger age group would likely need replacement beta cells, while the older age group may benefit from a treatment to kick-start their dormant beta cells. 

Other JDRF-funded researchers are now exploring both of these approaches. 

Professor Noel Morgan, one of the authors of the research, said: “The significance of this could be enormous in helping us to understand what causes the illness, and in unlocking avenues to prevent future generations of children from getting type 1 diabetes. 

“It might also lead to new treatments if we can find ways to reactivate dormant insulin-producing cells in the older age group. This would be a significant step towards the holy grail to find a cure for some people.” 

The research is available in Diabetologia

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