By: Linda DiMeglio, MD, MPH, professor of pediatrics professor of pediatrics
A difference, to be a difference, must make a difference- Gertrude Stein
Nearly 200,000 US children live with Type 1 diabetes. Diabetes daily management requires regular blood sugar checks, monitored diets, and insulin therapy. Therapy costs and the number of persons affected by the disease both are steadily increasing. Disease prevention and cures are urgently needed.
To meet these needs, researchers, including our team at Riley Children’s Hospital, have been working together for decades. Over time we have made significant progress in our understanding of the disease, including learning that persons develop type 1 diabetes for multiple reasons. Therefore, preventing and curing type 1 diabetes will require tailoring therapy to the disease process occurring for each at risk individual.
Determining who is at risk is the first step. We can test relatives of persons with diabetes using fingerstick blood samples to find antibodies directed toward the cells in the pancreas that make insulin. This testing is done in a free and confidential manner through the Type 1 Diabetes TrialNet clinical research network. Persons with antibodies can then be monitored for disease progression and even enter studies to prevent or delay disease onset. One such study recently demonstrated that a targeted treatment (with a drug called teplizumab) delayed the onset of disease for nearly 3 years. This proved both that researchers could identify persons at risk and that a drug therapy could delay the onset of disease. Our TrialNet group is now testing other prevention therapies.
Studies to date have focused on relatives of persons with type 1 diabetes who have a 15x greater risk of developing type 1 diabetes than persons without an affected relative. Since 85% of persons who develop type 1 diabetes do not have an affected relative, eventually screening will need to move to the general population and be incorporated into preschool well-child care. Academic discussions are beginning in earnest about screening all children for type 1 diabetes risk. Several general population screening initiatives in the US and Europe are being planned or underway. Two of the largest are a German study (Fr1Da) and a study in Colorado. Screening could reduce the rate of severe illness at the time of clinical diagnosis, improve blood sugar control, and lower overall care costs.
When will general population screening for type 1 diabetes be implemented here in Indiana? Only time will tell. But certainly, that time is drawing closer every day.
You can keep up to date with our Riley diabetes research team at @T1DIndy on Facebook and Twitter
