Advanced research reveals new type 1 diabetes finding
A first of a kind study has found one in three people with type 1 diabetes continue to produce insulin. Some patients still secrete insulin 40 years after first being diagnosed. The finding, according to researchers, has major implications for how type 1 diabetes is treated.
Research published in the journal Diabetes Care erases the long-held notion that type 1 diabetes destroys the body's ability to produce insulin. What that means, according to researchers, is more targeted therapies geared toward prolonging insulin production for those diagnosed with the disease.
New approach to treating type 1 diabetes
The study finding suggests there are biological difference in type 1 diabetes that depend on whether an individual is diagnosed at a young age or as an adult.
Asa K. Davis, Ph.D., T1D Exchange program manager at Benaroya Research Institute said in a press release that immunotherapy treatments are already being studied to help prolong insulin production, adding..."our findings underscore that those diagnosed at a young age may be more likely to benefit from such new approaches.”
Tests show children may benefit from immunotherapy for diabetes
For the study researchers used laboratory results from plasma, RNA, DNA, white blood cell and red blood cell samplings from people with type 1 diabetes from the T1D Exchange Biobank, stored at the Northwest Lipid Metabolism and Diabetes Research Laboratories at the University of Washington. The biobank stores biological samples from patients with T1D as part of a large-scale study designed to measure insulin production among type 1 diabetics of various age groups and duration of disease.
Type 1 diabetes that primarily affects children is thought to be the result of an autoimmune dysfunction that leads to the destruction of beta cells in the pancreas that begins even before the disease is discovered. The process continues after diagnosis.
Biological samples used in the study included people diagnosed with T1D from three to 80 years and age five to 88. A total of 919 samples were tested for C-peptide levels. Measuring C-peptide in the blood correlated with insulin production and is a test used to distinguish between type 1 and type 2 diabetes.
The results showed 46 percent of people diagnosed with type 1 diabetes before age 18 and 78 percent diagnosed after age 18 were still producing insulin, Even after 40 years of T1D onset, sixteen percent of diabetics with adult onset and six percent of childhood cases still showed insulin producing capability.
“Other studies have shown that some type 1 diabetes patients who have lived with the disease for many years continue to secrete insulin and the assumption has been that these patients are exceptional,” said .Carla J. Greenbaum, M.D., director, T1D Exchange Biobank Operations Center at the Benaroya Research Institute. The finding suggests otherwise, meaning 10 percent of patients with type 1 diabetes may not meet current guidelines through Medicaid, private insurance and Medicare for insulin pumps.
“Diabetologists have been, at times, confounded by the problem of patients being denied an insulin pump because their C-peptide levels defy the classic definition of the disease,” Davis added. “We can now quantify the number of patients who demonstrate continued insulin production, which will lead to raised awareness among general practitioners and insurers.”
The finding challenges how type 1 diabetes has been treated and provides proof for clinicians that insulin secretion can still occur among those diagnosed with the disease. The study authors also say the new research should mean better ways to treat the disease in addition to lowering the chances of misdiagnosing type 2 diabetes. The research could also provide insights into how the disease develops.
"Most People With Long-Duration Type 1 Diabetes in a Large Population-Based Study Are Insulin Microsecretors"
Richard A. Oram, et al
December 17, 2014