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Type 1 more common in Sweden than previously thought

Up to three times more Swedish young people are being diagnosed with type 1 than current estimates suggest, according to new research.

The finding suggests that other countries, including the UK, could also be undercounting the number of people with the condition.

Sweden is already known to have the world’s second highest incidence of under-15s with type 1, with 43 new diagnoses made per 100,000 children every year. In common with many other countries, this rate is increasing while the rate in adults has remained comparatively low and stable.

However, the numbers are based on two different sources: the Swedish Childhood Diabetes Register, which covers under-15s, and the Diabetes Incidence Study in Sweden (DISS), for people from 15 to 34 years old.

The new study, led by Dr Araz Rawshani of the Swedish National Diabetes Register, used another method to count the number of people with type 1. It looked at the prescribed drugs register for people who had been prescribed insulin, but never given oral glucose-lowering drugs (which are used for people with type 2 diabetes).

Although the prescription rate among under-15s matched the official rate almost exactly, there was a big difference for other age groups – for example, almost three times as many 15 to 19-year olds were being prescribed insulin as were being recorded in the DISS.

This suggests that there are many young people with type 1 who are not being recorded in the official statistics – which has implications for monitoring, research and even funding decisions in the future.

Earlier this year, JDRF launched #CountMeIn – the campaign to get more Government funding for type 1 research. If the number of people with type 1 is even higher than estimates suggest, this makes funding type 1 research more important than ever.

Dr Rawshani noted that this was an important finding, not just for Sweden, but for other countries around the world: ‘We now have a simple method to monitor [the condition] on a nationwide scale, but many more multinational efforts are needed to resolve the conundrum of type 1 diabetes.’

The research was published in the journal Diabetologia.


Diabetes no longer the leading cause of blindness

JDRF has long funded research into treating and preventing eye complications, from studies looking at genetic susceptibility, to our multi-million dollar collaboration with the UK company KalVista, which is developing a treatment for diabetic macular oedema.

Now, research from Moorfields Eye Hospital in London has found that eye conditions related to diabetes are no longer the most common cause of blindness in England and Wales – and suggest a focus on research is behind the fall.

The researchers, led by Dr Gerald Liew, looked at the number of people being registered as severely sight impaired or blind in both 1999 and 2009, and found that the proportion of people whose visual impairment was caused by diabetic retinopathy or maculopathy fell from 18% to 14%.

Over the same period, the proportion of people being registered as blind due to hereditary retinal disorders increased from 16% to 20%.

This makes it the first time since at least 1963 that diabetes-related eye conditions were not the most common cause of blindness in England and Wales, and it comes despite an overall rise in the number of people with diabetes, both type 1 and type 2.

This suggests that screening programmes and better treatments are having a marked effect on the progression of diabetes-related eye conditions, with the researchers noting that: “A prolonged focus on prevention and treatment of diabetic eye disease has most likely contributed to the decline in blindness certifications from this disorder among working age adults.”

Karen Addington, Chief Executive of JDRF, said: "This progress on tackling diabetes-related eye conditions is really positive news - congratulations to all JDRF supporters and researchers, who have played a genuine part in making it happen. But if we are to accelerate this sight-saving progress, the Government must play its part. UK Government investment into type 1 diabetes research has actually fallen by £3 million since 2009."

The research was published in the journal BMJ Open.


From ‘Patient’ to ‘Person’ – rethinking the way we treat people with diabetes

From 5 to 7 March 2014, diabetes specialists from across the country came together in Liverpool for the 2014 Diabetes UK Professional Conference. Alongside new technology and research announcements, one of the big themes to emerge from the three-day event was the importance of putting the person – not just their diabetes – at the heart of their treatment.

Right from the first day, this was clear: a workshop hosted by Dr Eleanor Kennedy, of the Diabetes Research and Wellness Foundation, and Professor Jane Speight, Director of The Australian Centre for Behavioural Research in Diabetes, provided researchers with the opportunity to learn how to adapt their language to suit a non-academic audience. The suggestion to avoid jargon was met with general agreement, but there was much more debate over words such as ‘control’ and ‘compliance’. These words are common to scientific papers, but are they unfair to the person with diabetes?

Professor Speight referred to Diabetes Australia’s position statement on language: a condition like diabetes can never easily be ‘controlled’ when there are so many external factors that affect it; using the word suggests the person should be able to manage their diabetes, and is to blame if things go wrong. ‘Compliance’ is similar – the person may not be matching the expectations of their healthcare professional, but the word implies this is the person’s fault, even if the guidance they receive is poor, or if there are difficult circumstances.

A later discussion hosted by Professor Stephen Greene of the University of Dundee asked whether we should be giving more or less flexibility to people receiving treatment for their diabetes, in terms of pumps and training styles. Some argued that we don’t give a choice of treatment for other conditions, but others countered that having a self-managed condition means that people need to be motivated – and everyone responds differently to different motivations.

The following day, JDRF-funded researcher Professor Colin Dayan of Cardiff University highlighted the importance of clinical trials to people with type 1. Just 5% of people with type 1 take part in a trial, but these trials are leading us to advances such as the artificial pancreas and drug treatments for type 1. He asked what might make people more likely to take part in trials – is it a question of wanting to know the risks, or is it simply that people aren’t being told about trials?

Dr Tim Tree, another JDRF-funded researcher, working at King’s College London, showed us how type 1 research has come along in his lifetime, offering his perspective both as someone with type 1 and as a researcher. When he was young, it was only possible to find out if someone had autoantibodies, or not. Now several different types have been discovered and it is known that having more than one kind heightens the risk of developing type 1. Forty years ago, it was discovered  that type 1 was an autoimmune condition; now Dr Tree is researching the mechanisms behind the immune system’s attack on the pancreas, isolating and characterising the cells responsible both for preventing and for leading the process.

Finally, a session on the artificial pancreas (a device that uses CGM readings to instruct an insulin pump to deliver the correct amount of insulin) announced some promising results. Dr Roman Hovorka, who is funded by JDRF and Diabetes UK and is leading the University of Cambridge artificial pancreas team, hopes to publish these later in the year. He also showed off the next generation prototype artificial pancreas – which uses an Android phone – which would make it much more portable for the people using it.

But the session went beyond the usual statistics such as HbA1c levels, including a talk from Dr Kath Barnard of the University of Southampton, who is tracking the psychological impact of the technology. She has seen how the artificial pancreas can improve the sleep and overall wellbeing of both the trial participants and their parents, and says that the majority of people on the trial are positive about its benefits – once more highlighting the importance of the person in their treatment.

JDRF tweeted from the conference. To read more and see pictures of the event you can follow the story here.


Vitamin D shortage in children at risk of type 1 diabetes

At JDRF, we are dedicated to curing, treating and preventing type 1 diabetes. This means that many of our researchers are looking for better ways to identify those at risk of developing the condition, so that we can deliver treatment as early as possible.

A new paper from a JDRF-funded study in Munich, Germany, has added to this knowledge by investigating the relationship between low vitamin D levels and type 1 diabetes, and finding a possible indirect link between the two.

Vitamin D is a hormone that is commonly found in fish oil and egg yolk, and is synthesised naturally in the body by exposure to sunlight. Historically, vitamin D deficiency has been linked to rickets and kidney failure in the elderly, but more recently, a lack of vitamin D has been linked to type 1, with some debate over the potential for dietary supplementation of vitamin D to protect against the condition.

The Munich team classified children into three groups: those with ‘pre’ type 1, based on the presence of immune cells called autoantibodies, which are a known predictor of type 1; those with type 1; and those having no autoantibodies and therefore no diabetes.

They then tested vitamin D levels in all three groups and found the group with no autoantibodies had the highest level of vitamin D, followed by the pre-type 1 and type 1 groups, respectively, suggesting that low vitamin D is more common in children with type 1 than in those without. 

Because of this, they highlight the potential for vitamin D deficiency to serve as an additional marker for risk of type 1.

This difference was only significant in the summer, when vitamin D levels rose in children without autoantibodies, but stayed low the other two groups. The researchers, led by Professor Anette-Gabriele Ziegler, suggest that a genetic susceptibility to low vitamin D levels, combined with reduced exposure to sunlight, may be behind this difference.

They also suggest that, rather than a direct link (such as type 1 being caused by low vitamin D), the vitamin D deficiency might be caused by elevated levels of autoantibodies, which in turn is a major factor in type 1 diabetes. Indeed, the researchers noted that among the children in the pre-type 1 group, variation in vitamin D levels did not affect the rate at which they later developed type 1 diabetes. This suggests that the two factors are linked, but not causally.

As a result, this research complements JDRF’s work into the environmental triggers of type 1. The TEDDY (The Environmental Determinants of Diabetes in the Young) study is tracking the diets and illnesses of young people at high risk of developing type 1, looking for potential triggers of the condition. Research that suggests that vitamin D is not a direct cause of type 1 will help validate the work if it finds a similar result.

The research was published in the journal Diabetologia.


New NICE guidance could recommend statins to everyone with type 1

The body that recommends treatments and drugs to the NHS has published new draft guidelines that could potentially see all adults with type 1 diabetes offered cholesterol-lowering drugs.

It comes as part of a range of changes suggested by NICE (National Institute for Health and Care Excellence) that seek to reduce the risk of cardiovascular diseases in the UK.

Currently, the cholesterol-lowering drugs, known as statins, are only recommended for prevention of cardiovascular diseases in people who have a 20% or greater risk of developing these diseases, and there is no guidance for whether people with diabetes, either type 1 or type 2, should receive preventative statins in this way.

Now, with the new guidelines, anyone with a 10% or greater risk of developing cardiovascular disease will be offered statins, and people with type 1 (and type 2) will be offered a high intensity statin treatment – between 20 mg and 80 mg of the drug atorvastatin (also called Lipitor).

The move is controversial, as statins, like all drugs, carry a risk of side effects, and you may have read reports in the Express or the Daily Telegraph that the new guidance will expose people to this risk unnecessarily. However, these articles described the risk faced by people without diabetes, or with type 2, both of whom can also reduce their risk by eating well and exercising more.

Muscle weakening and pains have been reported in some people, and there is also evidence linking statins to an increase in blood glucose levels. A 2012 study found the use of statins by people with type 2 diabetes raised HbA1c by 0.3 percentage points – meaning someone with an HbA1c of 7.5% could find their level increased to 7.8%.

Research strongly suggests that using statins in this way does reduce the chance of someone developing cardiovascular disease, and previous JDRF research found that people with type 1 who used statins had reduced levels of calcium in their coronary arteries, which is an early marker of a person’s risk of developing coronary artery disease in later life.

We are also funding the AdDIT trial in Cambridge, which is investigating the benefits of using statins preventatively in young people with type 1.

Because of these benefits, the extra cost of prescribing statins should be offset by lower costs associated with treating cardiovascular disease. The drugs currently cost £285 million a year, while treating heart disease costs the UK £9 billion annually.

As with any medicine, a decision about statin treatment should be made with the advice of a healthcare professional, and until the guidelines come into force, there is no obligation for the NHS to fund preventative statin therapy in this way.

The draft guidelines will be assessed by healthcare professionals, government organisations and patient groups until 26 March, and if there are no significant changes to be made, they will be published in July.


Behind the headlines: Is vitamin D protective against type 1 diabetes?

You may have read an article in The Telegraph today that suggests increasing a person’s level of vitamin D could help prevent type 1 diabetes.

The main role of vitamin D in the body is to keep bones and teeth healthy and there are many benefits to ensuring that you get the recommended daily allowance. The main source of vitamin D is sunlight but it is also found in oily fish, eggs and fortified cereals.

There has been a lot of research into this topic in recent years and there is potential evidence of a link between vitamin D deficiency and a number of conditions including type 1 diabetes.

Some research has indicated that many children and teenagers with type 1 do have low vitamin D levels, and there is evidence to suggest that there is variation in genes involved with metabolism of vitamin D in young people with type 1.

Other studies have shown that vitamin D may help preserve beta cell function in people with new-onset type 1.

However, no clinical trials have yet demonstrated that adding more vitamin D to a diet can conclusively prevent type 1.

The Department of Health currently recommends:

All pregnant and breastfeeding women should take a daily supplement containing 10 micrograms of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate foetal stores for early infancy.

All babies and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them to meet the requirement set for this age group of 7.0-8.5 micrograms of vitamin D a day.

However, babies who are fed infant formula will not need vitamin drops until they are receiving less than 500ml (about a pint) of infant formula a day, as these products are fortified with vitamin D.

Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.

People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D. 


DKA hospitalisations remain high among young people with diabetes

New figures have revealed that 2011-2012 saw over 6,200 hospital admissions among under-25s with diabetes (both type 1 and type 2) – with almost 40% of these being due to diabetic ketoacidosis (DKA).

The majority of DKA cases were among people who were already diagnosed as having diabetes, suggesting more needs to be done to help young people with their glucose management.

The report, produced by the Royal College of Paediatrics and Child Health, forms the second part of their National Paediatric Diabetes Audit. The first part, which you can read more about here, uncovered a significant gap between recommended checks (such as HbA1c and eye tests), and the care young people with diabetes are actually receiving.

This latest part covers the causes of hospitalisations amongst young people with diabetes. It highlights that the number of hospital admissions for DKA remains high, at around twice the level seen in 2005-2006. Young women in England saw the highest rate of admission for DKA, at over 11,500 hospitalisations per 100,000 people.

However, the numbers for most age groups and both genders were slightly lower than for the 2010-2011 period.

The report also found that 9% of hospitalisations – or 564 within 2011-2012 – were due to hypoglycaemia. This level was highest in children aged under 14 years, falling sharply in older groups. This may have been due to older people having developed better overall control or better ways of self-managing a hypo.

JDRF is funding several projects that would help people manage their blood glucose, including the artificial pancreas, a device that uses CGM readings to instruct an insulin pump to deliver the correct amount of insulin. You can read more about this research here.

The full RCPCH report can be read on their website here.


Race to develop artificial pancreas hots up

JDRF has long supported development of the artificial pancreas, a closed loop system that would include a continuous glucose monitor (CGM) and an insulin pump, and set up the artificial pancreas consortium to help promote development of this technology around the world. This includes 21 clinics located around the world that are all involved with some aspect of research into the artificial pancreas.

The 7th International Conference on Advanced Technologies & Treatments for Diabetes in Vienna, Austria, attended by JDRF, focused on the exciting developments that have happened recently that will help make the artificial pancreas a reality in the near future.

In the UK, Roman Hovorka from the University of Cambridge is leading the JDRF-funded efforts in this field. As reported in a paper published in Diabetes Care last year, he and his colleagues showed that adolescents using a prototype artificial pancreas over a period of 36 hours in a research facility had significantly lower and less variable blood glucose levels than those using conventional pump therapy. More recently, Hovorka and team have had positive results in home-based studies.

The Cambridge prototype is far from the only one being developed. Many other researchers around the world are working on similar but subtly different models, often aimed at different subgroups of people with type 1, and a large number of these projects were discussed at the conference. For example, Moshe Phillip and colleagues have developed and are testing the ‘Glucositter’ artificial pancreas in Germany, Slovenia and Israel; and Edward Damiano and his US-based team have developed and are testing a ‘bionic pancreas’ in Boston.

Advances in artificial-pancreas related technology were a key theme of the meeting. Manufacturers Dexcom and Medtronic have responded to the successes of the competing global artificial pancreas research groups by improving the efficacy of their pumps and sensors.

Dexcom’s G4 Platinum CGM, shown to be more accurate than Medtronic’s Enlite CGM in a new study presented in Vienna, has already been upgraded by the development of the G4AP. Dexcom developed the new sensor technology, which is even more accurate than the G4 Platinum CGM, in conjunction with the University of Padova in Italy, specifically for use as part of an artificial pancreas system.

Similarly, Medtronic has already improved upon its MiniMed 530G, the first available pump system approved in both Europe and the US with a “low glucose suspend” feature that will automatically stop insulin delivery from the pump for two hours when an associated CGM reaches a preset low blood glucose level. While the 530G system is considered to be the first step of six on the path to a working artificial pancreas, the Medtronic MiniMed 640G is thought to be the second. The difference between the 530G and the 640G is that the latter will suspend insulin when hypoglycaemia is predicted, whereas the former will only do so if a preset hypoglycemic threshold is crossed. Medtronic hopes to launch the 640G in Europe sometime between mid 2014 and early 2015, and in two-to-three years in the US.

A key to the puzzle that remains to be solved is the speed which insulin can be absorbed into the body from an external pump, as with currently available options there is a delay of up to 20 minutes between insulin administration and uptake in the blood which makes smooth interaction between a CGM and an insulin pump tricky. A faster acting insulin than those currently available could solve this problem, but has yet to be developed.

Another method of speeding up insulin delivery is by going via the stomach. Eric Renard from Montpellier University, France is an expert on ‘intraperitoneal’ insulin pumps and spoke about them at the conference. The main problem with these pumps is that they have to be implanted in the stomach and are therefore quite invasive for most people with type 1. However, they can be very effective at improving blood glucose control in people whose diabetes is difficult to control. Renard is hoping to develop an artificial pancreas with an intraperitoneal pump, in order to improve treatment for people with highly variable response to insulin. 

JDRF tweeted from the conference. To read more and see pictures of the event you can follow the story here.


Researchers uncover a link between infection and type 1

JDRF-funded researchers at the University of Cambridge have found evidence of a link between viral infection and the development of type 1 diabetes.

They discovered that a genetic response normally associated with infection preceded the first indications of the condition in children.

 “We can now move our research forward to dissect out what effects such an anti-viral gene response has on the immune system to increase the risk of autoimmunity and type 1 diabetes in very young children,” commented Professor John Todd, Director of the JDRF/Wellcome Trust Diabetes and Inflammation Laboratory at the Cambridge Institute for Medical Research, a co-director of the project.

He and JDRF postdoctoral fellow Dr Ricardo Ferreira, who led the research, believe their findings could lead to a way of identifying children at increased risk of type 1, even before they develop the immune system proteins, known as autoantibodies, that are currently the only immune system marker for the condition before symptoms arise.

Scientists have long known that there is a strong genetic element to being at increased risk of type 1. But not everyone with this increased inherited risk goes on to develop the condition.  Research suggests that environmental factors must be important but their identities largely remain elusive, with viral infections being the lead candidate. Last year, JDRF-funded research in Finland pointed to the coxsackie B virus as one potential environmental trigger.

The Cambridge research lends support to this idea. The genes identified are usually activated when the body produces a protein called type I interferon, which is emitted by cells when they encounter a virus.

Among children suspected to be at high risk of developing type 1 diabetes, these genes were most strongly activated, or ‘expressed’, in those who subsequently went on to produce autoantibodies to pancreatic cells, whereas children who did not develop this immune response during the study had lower levels of activation. 

In contrast, the genes were only weakly expressed in healthy participants and people who already had type 1 diabetes. This suggests that the response is limited to the period before the immune response is triggered, and could therefore lead to a way of identifying who is at greatest risk of developing the condition, allowing them to access treatment earlier than is currently possible.

Ferreira said: “We now have a handle on a potential biomarker that can be detected easily in a tiny blood sample that may indicate viral infections with predisposing effects in autoimmunity against the insulin-producing cells of the pancreas.”

The researchers also found a link to respiratory infections, as children who had a recent respiratory condition were more likely to have the high level of gene activation.

However, because the illness data was self-reported by parents, there was no record of which infections these were, beyond being respiratory tract infections. The researchers now hope to carry out a study with additional infection data, potentially allowing them to track the effects of viruses on type 1. The JDRF-funded TEDDY study, which is recording the infections, allergies and diets experienced by young people at risk of developing the condition, is one source they hope to use.

Karen Addington, Chief Executive of JDRF, said: “The results of this study certainly appear worthy of being explored further.  Type 1 diabetes is a challenging and complex condition. But it will one day be cured. It's just a matter of time, money and excellent research such as this.”

The study, funded by JDRF, the type 1 diabetes charity, and the Wellcome Trust, was published today in the journal Diabetes.


JDRF scientists make promising stem cell progress for type 1 diabetes

Articles in the Guardian and the Daily Mail today discuss a new JDRF research study which saw skin cells turn into functioning insulin-producing beta cells in mice.

The mice, which had a condition that mimics type 1 diabetes in humans, then experienced a fall in blood glucose.

The San Francisco-based study, part-funded by JDRF, took cells called fibroblasts and treated them with chemicals to make them similar to ‘endoderm cells’. These are the cells that, in an embryo, go on to form many internal organs, such as the pancreas.

Untreated fibroblasts would normally develop into collagen, which forms part of skin and bones.

This ‘reprogramming’ meant that when the cells were treated once more to make them develop further, they became precursors to pancreatic cells. When these were implanted into the mice with type 1 diabetes, the mice’s blood glucose levels fell. Removing the cells made their blood glucose levels rise again.

Beta cells are the cells that are killed off when an individual develops type 1 diabetes. This approach appears to show promise as a means of generating beta cells, particularly as transplants currently suffer from a lack of donors. It also complements similar work to generate beta cells from stem cells.

As such, JDRF is very pleased to have been involved in funding this research.

However, the headline from the Daily Mail, which read “could the cure for type 1 diabetes be in sight?” was overstating the progress that this study represents. It is important to note that the study has not yet been replicated in humans; as Julia Greenstein, vice president of cure therapies at JDRF in the US, told the website HealthDay: "This is a great study in mice. The next step needs to be to see if this happens in human cells. Mouse cells are very different. While we've learned a lot from the mouse, this needs to be adapted for humans.”

In addition, anyone receiving the transplanted beta cells would need to have some way to protect them from the immune system. The new cells would be replacing those lost to type 1 diabetes, and not treating the cause.

This means they would need to be used with, for example, a form of encapsulation therapy, such as those being developed by JDRF researchers. Other work is being done by Tim Tree at King’s College London to identify ways to prevent the immune attack on beta cells, without hindering the beneficial aspects of the immune system.


Wellcome Trust and JDRF: working together to drive autoimmune research

There are more than four million people in the UK with an autoimmune disease. Type 1 diabetes, which affects more than 400,000 people in the UK, is one of the best characterised and most common autoimmune conditions.

In June 2013 JDRF carried out an analysis of UK research into type 1 diabetes. The Type 1 Diabetes Research Roadmap highlighted that the UK is a world leader in autoimmunity research, but that collaboration between different groups of researchers could be improved.

Responding to this finding, JDRF worked with the Wellcome Trust to organise a meeting to discuss the common mechanisms of autoimmune disease and to encourage collaborative research in this area, which took place at the end of January. The event attracted leading researchers from around the world.

Professor Matt Brown from the University of Queensland Diamantina Institute in Brisbane, one of four keynote speakers at the conference, explained that ‘over the last seven or eight years big progress has been made in the genetics of immune-mediated diseases because people realised that we all had to collaborate globally on specific diseases to be able to actually make any progress.’

Although it is still early days, collaboration among autoimmune researchers has already led to benefits for patients. 

Professor Mark Peakman of King’s College London, chairman of the steering committee for the meeting praised the meeting, saying that it was ‘a beginning in that direction and its success suggests we should build more capacity in this area.’

To read a full report from the event, as well as the latest type 1 news and research progress, sign up to our bi-monthly email newsletter today.


Successful JDRF-funded clinical trial continues to recruit participants

Researchers at the University of Cambridge, working with the city’s Addenbrooke’s Hospital, are developing a potential new treatment for people recently diagnosed with type 1 diabetes.

The ‘Adaptive study of IL-2 dose on regulatory T cells in type 1 diabetes’ (DILT1D), is investigating an approved drug called aldesleukin, for its potential in treating type 1 diabetes. The team is looking at whether this medication can restore the balance to the immune system in those recently diagnosed with the condition and if so, what dose of the drug is required for the best results.

The researchers, who launched the trial last April, have already treated 29 individuals and are now seeking to recruit further participants to hit the final target of 40 patients.

In addition to the funding it receives from JDRF and the Wellcome Trust in their partnership funding for the Diabetes and Inflammation Laboratory, the team, led by Dr Frank Waldron-Lynch, has recently won the 2013 Biomedical Award of the Sir Jules Thorn Charitable Trust, receiving a grant of just over £1,000,000 for a second follow-up trial based on the initial results of DILT1D.

Dr Frank Waldron-Lynch, Chief Investigator for the trial, said: “A small dose of this drug might strengthen the regulation of the immune system and slow up destruction of the insulin-producing cells in the pancreas. We are keen to have the type 1 diabetes community help us with this new clinical research and develop a potential new treatment.”

Kris Wood, Donor Development Officer at JDRF and who participated in the trial, said: "The nurses in the DILT1D study provided me with an excellent level of care. I had regular check-ups and tests which gave me peace of mind and enabled me to learn a lot about my own body and living with the condition. Studies like this are helping to treat type 1 diabetes – it’s only a matter of time, money and excellent research until we find a cure.”

If you are aged 18-50 and have been diagnosed with the condition in the past two years, then you may be eligible to apply.

To find out more about what participation involves please contact a member of the team in the University’s Cambridge Institute for Medical Research by email on or telephone 01223 762327. You can also find out more information on their website or on Facebook and Twitter.


Eyes take prize in JDRF's 2013 photo competition

We asked our researchers to send in a photo that showed their research in action, for the chance to win a £500 travel bursary (£250 for the runners-up). Here are the three winning entries, with explanations from the researchers themselves.


Georgios Ponirakis, Clinical Research Coordinator at The University of Manchester

Our team at The University of Manchester has pioneered the use of Corneal Confocal Microscopy (CCM). This process allows us to examine the eye from its surface, giving us a rapid, non-invasive way to monitor nerve damage in people with diabetic neuropathy. We have also developed automated image analysis software to rapidly assess the structure of nerve fibres.

The JDRF grant I won from the photography competition was used to fund my travel expenses to the Neurodiab Meeting in Barcelona. This conference provided me the opportunity to hear from a wide range of inspiring speakers from around the world about different aspects of diabetic neuropathy.



Dr Rupert Kenefeck, Postdoctoral Fellow at UCL

Our lab is interested in determining which subset of immune system T cells is implicated in type 1. To do this, we label our cells with fluorescent tags, then pass them through a fluorescence associated cell sorter (FACS) at up to 20,000 cells per second. Using lasers, the machine detects cells with a specific combination of tags and adds a charge to the tiny droplets of water containing them. This charge directs the droplets into collection tubes for later study. Here 4 streams of droplets are being collected alongside the central discard stream.

I used the prize money to visit the British Society for Immunology Congress before Christmas where I presented some of our most recent data. It was a great opportunity to see some of the most recent ground breaking immunological research and to meet other researchers from all corners of the world.

James Bockhart, Research Student at the University of Brighton

These images show a new material, BioVyon™, that has been designed to mimic the environment of the pancreas. This property makes it ideal for culturing beta cells for transplantation – a potential treatment for type 1.

The left-hand image shows the material magnified 100 times by scanning electron microscopy, revealing details of its surface chemistry. The right-hand image shows it as visualised with fluorescence microscopy. Blue and pink indicate a viable cluster of beta cell analogues after 3 days of culture.

I intend to use the prize money to travel to the Diabetes UK conference in Liverpool. This will provide me with a chance to network and catch up with researchers in my field, discuss current projects, and explore compound interests in my research area. My work so far has investigated three dimensional cell culture methods with the aim of mass culturing beta cells for islet transplantation. Discussing ideas and problems with other scientists is an excellent way to progress and develop a foundation of contacts to aid future work.

Without your support research like this would not have been possible, please help us continue this world class type 1 diabetes research in the UK.


New JDRF research asks why some people develop type 1 more slowly

The autoimmune process leading to type 1 diabetes can develop quickly in some people but very slowly in others, despite both groups having similar early indicators of the condition. Now, thanks to JDRF funding of £400,000, a new UK study hopes to discover why this is the case.

Researchers from the University of Bristol’s Diabetes and Metabolism Research Group aim to identify these ‘slow progressors’ in groups of participants from existing long-term studies, and determine what sets them apart.

Type 1 diabetes occurs when part of the immune system, known as T cells, starts attacking the beta cells in the pancreas. But the researchers, led by Dr Kathleen Gillespie (pictured), believe that a related type of protective immune cell, called a regulatory T cell, works more effectively in slow progressors than in people who develop type 1 more rapidly. These regulatory T cells monitor the immune system’s T cells and stop them from attacking the body.

This suggests that if the Bristol team can identify what causes slow progression, their results could potentially lead to a treatment to delay the onset of type 1 in others.

Dr Kathleen Gillespie, who is leading the research, said: ‘It is well established that the presence of two or more islet autoantibodies in the blood is a very accurate marker for future type 1 diabetes.  Yet some ‘at risk’ individuals remain diabetes-free for decades.’ 

‘The aim of our study is to identify how the onset of diabetes is delayed for many years in some individuals.  We believe that understanding the nature of this protection will ultimately help protect others.’

A number of other JDRF researchers such as Dr Els Henckaerts are already investigating regulatory T cells as a possible route to a cure. You can read more about their research here.

Help JDRF continue funding world class type 1 diabetes research in the UK like this project – donate now.


Molecule supports glucose removal without raising hypo risk

JDRF-funded researchers in Boston, USA, have developed a way to support insulin in removing glucose from the blood, without increasing a person’s risk of hypoglycaemia.

The chemical, known as a glucokinase activator, could also indirectly improve the survival rate of beta cells, and so could theoretically be used to treat both the causes and the symptoms of type 1 diabetes.

Glucokinase activators are so called because they support the work of molecule called glucokinase. This is produced by the body to help remove glucose from the blood, converting it into a similar chemical that can be either stored or broken down. Because of this, glucokinase activators have been investigated in people with type 2 as a complement to insulin in lowering glucose levels.

In addition, some studies have suggested that the presence of glucokinase supports healthy beta cell growth, which would be beneficial to people with type 1. This would also require a glucokinase activator, since in the body glucokinase production is encouraged by rising insulin levels – something that people with type 1 lack since they no longer produce their own insulin.

However, previous attempts at formulating glucokinase treatments have focused on changing the shape of the glucokinase molecule to make it better at interacting with glucose. This is useful when glucose levels are high, as the removal can happen more quickly, but when glucose levels fall, this increased ability to react runs the risk of causing hypoglycaemia, since unmodified glucokinase would normally stop working below a certain level.

The research team, led by Drs Loren Walensky and Nika Danial, created a new glucokinase activator that drives glucokinase to remove glucose more efficiently, but stop once levels fall to normal – at the point when it naturally stops working.

This would allow it to work without increasing the person’s risk of hypoglycaemia.

Although the research is currently at an early stage – in pre-clinical lab studies – the investigators suggest the molecule could eventually be used alongside insulin to help manage glucose levels. They predict that this will be especially useful for people with type 2, given the lower levels of glucokinase found in people with type 1, but say that ‘improvement of both beta cell function and mass through increased glucokinase activity may well expand the potential utility of synthetic glucokinase activators beyond [type 2] to restoration and maintenance of functional beta cell mass for the treatment of type 1 diabetes.’

The research was published in the journal Nature Structural & Molecular Biology.


Children with diabetes not receiving adequate care

Just 6.7% of children with diabetes in England and Wales (96% of whom have type 1) are receiving their full set of annual recommended checks, a report by the Royal College of Paediatrics and Child Health has revealed.

This is a slight improvement over last year, when only 5.8% of children received all seven checks recommended by NICE. However, it stands in stark contrast to the 60% of adults who are receiving the full level of care.

Missing out on these checks, which include HbA1c monitoring, blood pressure tests and eye screens, means that any developing complications are less likely to be spotted early. In many cases, early treatment of complications can significantly reduce their impact.

The report also found that just 17.4% of children are meeting the HbA1c target of below 58 mmol/mol (7.5%), with over 25% having levels above 80 mmol/mol (9.5%).

These numbers were also slightly improved from last year, when 15.8% of children met the target, although a change to the way HbA1c levels were recorded means the results may not be comparable.

High HbA1c levels are an indicator of poor glucose control, and can increase the risk of long-term complications. For this reason, NICE recommends that children with levels consistently above 80 mmol/mol (9.5%) should be offered additional support by their diabetes care teams to help them improve their glycaemic control.

Dr Justin Warner, who co-authored the report, said: ‘Diabetes is a serious, yet manageable, condition. It is heartening to see some improvement in numbers of children and young people with diabetes achieving excellent glucose control, but it is also concerning that significant numbers of children still do not have access to a level of control that would reduce their risk of developing associated complications long-term.’

Karen Addington, Chief Executive of JDRF, said: ‘It is deeply concerning to hear that children with type 1 diabetes who face the risk of devastating complications from their condition are still not receiving all the checks recommended by NICE to help reduce this risk. It highlights once again why research into type 1 diabetes and its complications, and access to the treatments that come from this, is so vital.’


Age of type 1 onset can predict risk in siblings

JDRF-funded researchers at the University of Bristol have found that a person’s age at the onset of their type 1 diabetes can indicate how likely it is that their siblings will also develop the condition.

This finding could make it easier to identify which people are at greater risk, and allow them to receive treatment earlier than is currently possible.

The research looked at 138 pairs of siblings registered in the Bart's-Oxford family study, which has been tracking young people with type 1, and their families, since 1985.

These pairs were chosen because, in each case, the sibling with type 1 had a specific genetic combination that is thought to be very important in determining genetic susceptibility to the condition.

It was found that for children who developed type 1 before the age of 10 years, 23% of their siblings also developed the condition before the age of 15. A further 29% developed autoimmunity towards insulin-producing cells, which is often seen as a precursor to type 1 diabetes.

In comparison, the figures were just 3% and 6%, respectively, for the siblings of those whose type 1 developed after their 10th birthday.

This suggests that there are extra factors – genetic or environmental – that may be influencing both siblings, prompting both an earlier onset and increased susceptibility.

Study researcher, Professor Polly Bingley, said the findings could be used to support future preventive treatments: ‘If you could identify people at risk at a younger age, then you could theoretically start primary prevention before they develop their antibodies.’

This would allow people to avoid any lasting effects that might occur if treatment is started later.

The team now hopes to investigate what causes this increased risk, with one candidate being epigenetic influences. These are changes to the way the body interprets its genes, caused by external factors.

‘Looking at epigenetics is becoming increasingly relevant and it’s something that we’d want to do,’ said Bingley.

The research was published in the journal Diabetes.


Psoriasis drug shows potential as type 1 treatment

A small JDRF-funded study in the USA has suggested that alefacept, a psoriasis drug, could be used to treat some aspects of type 1 diabetes.

The researchers, led by Professor Mark Rigby at Indiana University, found that newly-diagnosed patients taking the drug needed fewer doses of insulin over the 12-month period than those who were given a placebo.

The first group also experienced fewer hypoglycaemic events during this time.

Psoriasis, like type 1 diabetes, is an autoimmune condition, and alefacept is thought to work by suppressing the immune system T cells involved in both conditions, while leaving protective cells unaffected.

According to Rigby, ‘Alefacept is the first targeted biological drug assessed in patients with new-onset type 1 diabetes that significantly depleted the T cells which attack the pancreas in type 1 diabetes, while preserving other immune cells which are important for pancreatic function.’

This action is what made it a potential target to treat people with type 1. However, it would need to be used before the complete loss of insulin-producing beta cells, within the first few months of diagnosis.

Although the study showed some promise for the 33 patients who received the drug, larger and longer term trials will now be needed to see how long the effects might last, and if there are any long-term effects of taking the drug. The current trial will continue for a further year, and if the results are encouraging, it may be followed by a full-scale phase III clinical trial, a process that may take 5-10 years to complete.

The study’s findings were published in The Lancet Diabetes & Endocrinology.


Scientists grow insulin-producing cells using protein injections

Researchers in Belgium have successfully generated insulin-producing beta cells from other pancreatic cells in mice with type 1 diabetes. The mice were then able to control their own glucose levels without additional insulin.

The study, part-funded by JDRF, was published in the journal Nature Biotechnology.

In people living with type 1, the immune system attacks the beta cells of the pancreas, leaving the person unable to produce insulin. This means they cannot control their own blood sugar, and must rely on insulin injections to stay alive.

However, the other pancreatic cells remain functional, and reprogramming these to produce insulin is a potential pathway to treating the condition.

The researchers first simulated type 1 diabetes in the mice, then after five weeks gave some of these mice a course of proteins that have been known to stimulate beta cell growth in the lab.

The treated mice subsequently began producing insulin, and their blood glucose levels fell to match those of mice with functioning beta cells. The other mice continued to experience high blood glucose levels.

By tracing the genetic origin of the newly grown beta cells, the researchers found that they were mostly derived from another type of pancreatic cell, called acinar cells. These normally help the pancreas secrete digestive juices, and are not involved in insulin production.

Dr Harry Heimberg, the study's Principal Investigator, from the University of Brussels Diabetes Research Centre, said: “Several characteristics make acinar cells ideal candidates for reprogramming to beta cells in the pancreas: they are the most abundant cell type, their microenvironment is identical to that of beta cells and they are not affected by diabetes."

This study provides hope for those living with type 1 diabetes, but more research will be necessary to see if the findings can help those living with the condition, as it is likely that the immune system would still attack any newly-formed beta cells.

Dr Heimberg added: "We hope that our model will contribute to the development of a robust and safe strategy for beta cell therapy in diabetes."

Karen Addington, Chief Executive of JDRF, said: “The results from this study are interesting, and certainly appear deserving of further exploration. Type 1 diabetes is a challenging and complex condition. But it will one day be cured. It's just a matter of time, money and excellent research."


Baby blood test could predict type 1 risk

Researchers in Italy may have found a link between type 1 diabetes and low levels of carnitine, a chemical produced naturally by the body and found in foods such as meat, fish and dairy, at birth.

The team looked at blood samples taken from 250 newborn babies from Umbria and Tuscany, and measured their carnitine levels.

They found that babies who later went on to develop type 1 diabetes had lower levels of carnitine than those who did not.

The study suggests that screening newborns for carnitine levels could be a way to predict who might be more likely to develop type 1, although more research would be needed to work out how low carnitine levels would need to be for type 1 risk to increase. This would allow doctors to be more vigilant for signs of the condition, enabling them to start treatment earlier.

The Italian team also suggested that low carnitine levels might be responsible for raising the risk of type 1. They believe that low carnitine levels might stop the babies’ immune systems destroying any ‘autoreactive’ T cells – the ones that attack the body’s insulin-producing beta cells.

However, in order to see if this is the case, the researchers would need to show that altering the level of carnitine changes the risk of developing type 1 diabetes. They hope to do this by giving a carnitine supplement to babies with low levels, to see if they have a reduced risk of developing the condition compared with babies without the supplement.

The research, published in the journal Nutrition & Diabetes, was led by Professor Gian Franco Bottazzo, former scientific director of Bambino Gesù Children’s Hospital in Rome. Bottazzo was one of the first people to suggest that type 1 diabetes is an autoimmune condition.

This work complements that of JDRF-funded researcher Ricardo Ferreira and colleagues at the University of Cambridge who are also working on early identification of babies likely to develop type 1 by screening for inherited proteins or markers in the blood that could convey increased risk for the condition. This work is being carried out in conjunction with scientists at the Diabetes Research Institute in Munich in Germany.