Type 1 diabetes: precision medicine at DUKPC – by Kotryna Temcinaite
I spent last week in Manchester at the Diabetes UK Professional Conference. I saw and heard a huge amount of science over the three days, but the strongest message echoing in the conference talks was that diabetes is not all the same: we need to treat it on case-by-case basis.
And we need to move towards precision medicine, where treatments are prescribed according to a person’s specific needs.
So what progress has been made and what gaps do we need to fill?
Type 1 diabetes – not one type of diabetes at all?
We can’t move forward without understanding Type 1 diabetes better, from what causes it to how it progresses. Researchers from the University of Exeter Medical School are really widening our understanding of Type 1 diabetes.
Professor Noel Morgan talked about his research on the immune attack against the pancreas. While analysing samples of pancreas taken from people with Type 1 diabetes, he noticed that some had two types of immune cells (called T cells and B cells) present, while others had mostly T cells. Interestingly, the double immune attack was only seen in those who were diagnosed before the age of seven.
These results were supported by Dr Richard Oram’s work, also presented at the conference. Dr Oram was looking at how Type 1 diabetes progresses. He saw that people diagnosed at an earlier age were losing insulin-producing beta cells much faster.
These results suggest there are two different versions of Type 1 diabetes: younger children could have a more aggressive form and lose insulin-producing cells faster, while people diagnosed later could have more gradual beta cell loss. Now we have to figure out if we can approach both cases separately, to help tailor the most effective treatments to different people.
Recognising Type 1 diabetes in different ethnicities
Another obstacle in our way towards precision medicine is that diabetes is thought to be different in people from different ethnic backgrounds.
At the conference, Dr Shivani Misra presented her results from the MY DIABETES study. She looked at how closely South Asian and European people met the biochemical, clinical and immune system criteria for Type 1 diabetes. Dr Misra found that these different parameters vary between ethnicities. Again, we need to start thinking about how to take this into account, to better tailor diagnosis and treatments.
Computers vs. doctors?
It’s not always easy to tell Type 1 and Type 2 diabetes apart. While they’re very different conditions, the symptoms can sometimes appear as similar. For example, people of a healthy weight can develop Type 2 diabetes and people can be diagnosed with Type 1 diabetes when they’re older.
Doctors know that certain characteristics are associated with a particular type of diabetes, but it might be difficult to assess which characteristic is the most important on case-by-case basis. This is what Anita Grubb was talking about at the conference.
She presented work around a new risk calculator, which is essentially an app that doctors can use to help them with diagnosis. They can input different measures, such as age, sex, blood glucose measures and body mass index. The app comes back with a value of how likely the person is to have Type 1 diabetes.
Of course, methods like that need further refinement, but being able to diagnose different types of diabetes accurately is incredibly important.
Exercise – good, risky and how can we manage it?
Professor Michael Riddell from Toronto summarised our current knowledge of exercise and Type 1 diabetes. It looks like exercising after a meal is the best choice, to avoid hypos. But research can’t give any personalised advice at this stage. Even though we know that the body responds differently to aerobic exercise (like running) and anaerobic exercise (like heavy weight training), researchers also think we respond to exercise in different ways as well.
This thought was closely mirrored by athlete Tom Neal, who hasn’t given up sports after his Type 1 diagnosis. He stressed that people with Type 1 diabetes have to constantly monitor their condition and adapt, and what works for you on Monday might not work on Tuesday.
Precision medicine is slowly becoming a norm for some conditions, but we’re not there yet with diabetes. That said, work at the DUKPC showed me just how many important steps are being made in research that will ultimately bring us closer to personalised treatments.
I’ll be summing up Type 2 diabetes research at the DUKPC in my next post!