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Behind the headlines: The Daily Mail – fact or fail?

The Daily Mail this morning reported the results of a study from the Lancet under the headline ‘Women with type 1 diabetes are 40 per cent more likely early to die than men with the disease’.

Yet as many people rightly pointed out in the article comments, this headline is somewhat misleading. It could lead people to think that women with type 1 diabetes more often die much younger than men with the condition. This is not the case.

It’s well-known that, on average, women live longer than men. However, in people who have type 1, both men and women have similar lifespans. This means that the effect of type 1 diabetes on lifespan is more pronounced in women than in men ­– this is where the Mail’s 40 per cent statistic comes from. The effect on women is 40 per cent bigger than the effect on men, which amounts to both men and women living a similar amount of time.

The same is true for the other statistics – women tend have lower rates of cardiovascular disease and stroke than men, so if type 1 puts both genders at a similar level, then the effect of having the condition is much bigger for women. They are not, as the Mail suggests, 37 per cent more likely to die of a stroke than men; it is that the effect for women is 37 per cent greater.

In addition, the overall effect of type 1 diabetes upon mortality is getting less and less every year. Last month, we reported a study that showed that people with type 1 are living longer than ever before, and we are funding numerous projects such as AdDIT to combat the threat of complications.

Despite this, both the Mail article and the Lancet study highlight an important point – women with type 1 are being more strongly affected by the condition than men, and we need to address this discrepancy. Studies have found that women have slightly higher HbA1c levels over their lifetimes, and as long-term hyperglycaemia raises the risk of complications, this could contribute to the difference.

Better treatments to support glucose management – including smart insulins and the artificial pancreas – would go a long way towards reducing the impact of type 1 on everyone.

Sarah Johnson, Director of Policy and Communications at JDRF, said: ‘We know that research has shown young girls and women with the condition are more likely to have poorer blood glucose control than their male counterparts. Whatever the reasons are behind that, what’s certain is that every single early death linked to type 1 diabetes is unacceptable.’

She added: 'One day, the cure will be found. To get there, we need research to be better supported.'


Inhaled insulin launches in the US

Afrezza, the inhaled insulin developed by MannKind and licensed to pharmaceutical company Sanofi, has gone on sale in America this week. This means that American adults with type 1 or type 2 diabetes can now get Afrezza on prescription as a bolus insulin.

However, the drug is not yet approved for people outside the US, for children or for people with chronic lung conditions.

Afrezza is taken using a thumb-sized inhaler at the start of the meal, and passes through the lungs into the bloodstream. The peak insulin level in the blood occurs around 12-15 minutes after use, making it more similar to insulin produced naturally by the pancreas in people without type 1. Most ‘rapid’ insulins peak 30-90 minutes after use.

This led JDRF to fund a trial using Afrezza in 2010, as part of a programme developing faster insulins for the artificial pancreas. The participants used it at meals to fine tune their blood glucose levels, alongside the slower-acting insulin being given by the artificial pancreas. This led to smaller blood glucose level peaks at mealtimes.

An additional benefit of the drug is that it could be used as by people who do not want to inject insulin. Pierre Chancel, Senior Vice President of Sanofi’s Diabetes Division, commented: ‘There is a recognized need for an insulin that doesn't require an injection, and our organization is committed to making this new treatment option available to patients.’

We previously covered Afrezza in June 2014 when it was approved for sale by the FDA, making it the only inhaled insulin on the market. A previous inhaled insulin developed by Pfizer, called Exubera, was withdrawn after poor sales and suggestions of an increased risk of lung cancer.


Behind the headlines: a probiotic cure for diabetes?

This morning, the Daily Express ran a headline saying ‘Breakthrough pill can CURE diabetes: New drug fights both types of killer disease’. So is it true, can a pill now cure both type 1 and type 2 diabetes?

Sadly, no. But the study behind the headline is really interesting.

Researchers at Cornell University, led by Professor John March, have developed a ‘probiotic’ pill containing modified bacteria that are typically found in the human gut and given them to rats with diabetes.

Central to the story is a hormone called glucagon-like peptide 1, better known as GLP-1. GLP-1 helps to regulate the body’s response to glucose in a meal. It does this by blocking the production of glucagon, so that glucagon does not act to raise glucose levels in the blood still further.

Professor March’s team engineered bacteria so that they would produce GLP-1, then gave a group of diabetic rats feed supplemented with this new ‘probiotic’ and compared them with a group of diabetic rats with un-supplemented feed. Rats given the supplemented feed developed insulin producing cells in their gut – some of the regular gut cells were ‘reprogrammed’ to make insulin. This meant that they showed significant increases in their insulin levels and the research teams estimated that these cells were sufficient to produce up to 33 per cent of a healthy rat’s insulin capacity.

So while this study does not herald a cure for type 1 diabetes, it does show that GLP-1 may have an important role to play in improving treatment for people with the condition.

GLP-1, and molecules that mimic its effect (known as GLP-1 agonists), have been widely researched in type 2 diabetes, and there are now a number of GLP-1 agonists available to help in treating type 2 diabetes. But these drugs have only recently started being investigated in type 1 diabetes – thanks in part to funding from JDRF.

Rachel Connor, Head of Research Communication at JDRF comments: ‘The Cornell team’s study adds to our understanding of the role GLP-1 and also demonstrates a novel way of increasing GLP-1 levels in the body. It’ll be interesting to see whether the same effects can be observed in humans with diabetes.’


JDRF researchers discover cell behind type 1 diabetes

Researchers at London’s Royal Free Hospital have found the immune system cell responsible for triggering the destruction of insulin-producing cells in type 1 diabetes.

Their finding could lead to new treatments that target this triggering process, potentially offering a way to cure or even prevent the condition.

Type 1 occurs when the body’s own immune system, which is meant to fight off diseases, attacks the cells in the pancreas that make insulin. Previous research has found that T cells, part of the immune system, are behind the attack, but this is the first time researchers have identified the specific kind of T cell involved.

The London team, led by Professor Lucy Walker, studied T cells from people with and people without type 1. They found that samples from people with type 1 contained much higher levels of molecules associated with a kind of T cell known as a ‘follicular helper T cell’.

These cells have previously been implicated in other autoimmune conditions such as lupus, but this is the first time they have been identified as being behind the autoimmune attack in type 1.

“Knowing more about the type of T cell that causes type 1 is definitely good news for future treatments” said Professor Walker. “It provides us with a new way of thinking about the cells that are causing the problem, and may allow us to develop different ways of interfering with them.”

While the discovery offers potential for research into a cure for type 1, it could also support research into preventing the condition, explained Professor Walker: “Measuring the level of this specific type of T cell in the blood could turn out to be a way of assessing someone's risk of developing type 1 ­– this is an idea we'd like to explore in the future.”

The study was published in the Journal of Clinical Investigation.


People with type 1 diabetes living longer, healthier lives

JDRF-funded researchers at the University of Dundee have found that people with type 1 diabetes are living longer than ever before.

While previous estimates have suggested that type 1 can reduce life expectancy by 15-20 years, Professor Helen Colhoun and her colleagues found this gap had narrowed to 11 years for men and 13 years for women. The difference was even smaller for older adults, reaching single digits for people aged 50-54.

Overall, life expectancy for people with type 1 has improved tremendously in just the last 40 years. In 1975, the difference between people with and without type 1 was almost 30 years, shrinking to less than 20 years in the 1990s.

However, the study shows that there are still improvements to be made, which is why JDRF continues to fund research into complications. AdDIT, a trial being run at the University of Cambridge, aims to prevent young people from developing heart and kidney diseases – highlighted by the Scottish research as two of the biggest factors that reduce life expectancy.

Better treatments, too, have an important effect. While good blood glucose control is encouraged at all ages, a US study also released today found good glucose management early on after diagnosis can give people with type 1 longer, healthier lives. JDRF-funded research into glucose control treatments such as the artificial pancreas and smart insulin is designed to make this challenging job, much easier.

Both the Scottish and American studies were published in the Journal of the American Medical Association.


Winners announced of 2014 research photo competition

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

1st place

Georgios Ponirakis, Clinical Research Coordinator at The University of Manchester

The photos show our team using In Vivo Corneal Confocal Microscopy (IVCCM) to test for nerve damage caused by type 1 diabetes. Nerve damage is a common complication of diabetes, so a rapid, non-invasive, clinical assessment technique for its detection - such as IVCCM - is useful to predict and prevent further complications.

We hope that by screening for long-term complications early on, we can prevent them from developing.

2nd place

Dr Sarah Cross, Postdoctoral Research Scientist at the Nuffield Department of Surgical Sciences and Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford

In June 2014, the Oxford Centre for Diabetes, Endocrinology and Metabolism held its first public engagement event, entitled 'Unravelling the Mysteries of Diabetes'. Our aim was to create fun and interactive ways to explain, to both adults and children, the diabetes research that is carried out in our centre, in order to make our research more accessible to the general public.

This photograph was taken during one of the guided tours of the DRWF Human Islet Isolation Facility, in which we demonstrated how we collect the parts of the pancreas that make insulin, the islets of Langerhans, from a donated organ in our clean room labs. These tours proved extremely popular with the public, who were able to discover both the long history of islet transplantation research in Oxford and how it is now translated to the clinic to combat hypo unawareness and allow insulin independence in patients with severe type 1 diabetes.

3rd place

Dr Sarah Cross, Postdoctoral Research Scientist at the Nuffield Department of Surgical Sciences and Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford

Islet transplantation is a classic example of recent research in type 1 diabetes that has enabled a novel treatment to be translated from 'bench to bedside'.

This series of photographs illustrates the process of human islets being extracted from a donor pancreas, infused into the recipient’s liver, and the transformation of a patient’s life from life-threatening hypo unawareness to stable blood glucose levels (and, in this patient, prolonged insulin independence). The microscopy image demonstrates the complex structure of the pancreas and the ongoing challenges of islet isolation. This challenge forms a central component of our JDRF-funded research.


From one, to five, to more? The smart insulin story so far

This autumn we’ve been talking about how being a #TypeOnesie could help support JDRF’s research on smart insulins. So Rachel Connor, Head of Research Communication at JDRF in the UK used the opportunity to find out more about the smart insulin research we’re already funding.

JDRF’s smart insulin story began around the same time as I joined JDRF, in 2008. Not long after joining the team, I heard about a company called SmartCells, Inc., that we were helping to develop a type of insulin that would only be active when glucose levels rose and would stop working as soon as those levels fell again. The simplicity of this idea grabbed me right away. I was delighted when the data showing that this crazy new idea for insulin looked promising enough for pharmaceutical giant Merck to buy up SmartCells, Inc. in 2010 enabling them to lend their formidable drug development expertise to the project. It’s a great story to illustrate how far JDRF’s money can go by investing in promising new ideas, so it’s a story I never get tired of telling!

But did you know JDRF has five smart insulin projects in active funding right now?

Three of these are one-year innovative grants, which allow scientists to start to explore an idea that looks nice on paper, but isn’t guaranteed to work. One project is working with the molecular building blocks of insulin to see if it can be rebuilt so that it still works in the same way as usual, but only when there is enough glucose in the blood stream to activate it. Another is screening a library of possible drug molecules that might help people with type 1 to automatically control their blood glucose levels. The final project is focusing on the interaction between insulin and the insulin receptor that allows cells to take up glucose from the blood stream and seeing if modifying this interaction could be useful for people with type 1.

We also have two longer term grants that are starting to examine whether ideas for smart insulin that seem to work in the test tube will work in animal models of diabetes. In Texas, a team is looking at a way of packaging insulin in a clever framework of ‘bubbles’ that will only allow insulin to escape when glucose levels rise. And in California, researchers are trying to make a form of insulin that is stable in the body for a long time, but is only activated when glucose levels are high, through a process of ‘competitive binding’.

And what next? Scientists have recently been sending proposals into JDRF with more ideas for how to develop smart insulins. Experts around the world are now helping us to work out which of these ideas are most promising and should be developed with JDRF funding – so who knows how many more ideas we’ll be working on in a few months’ time? One thing is for sure – being a #TypeOnesie will help us support these projects.

Are you being a #TypeOnesie on World Diabetes Day? Find out more here »

You can find out more about smart insulins by clicking here »


Could a blood pressure drug help beta cells survive? People with type 1 diabetes will soon help researchers find out

A new clinical trial is due to begin shortly, testing whether a commonly used blood pressure drug, verapamil, can help remaining insulin-producing beta cells survive in people newly diagnosed with type 1 diabetes.

The trial is the result of many years of laboratory research – much of it supported by JDRF – gaining insights into how beta cells work in people with diabetes. The research team, led by Dr Anath Shalev at the University of Alabama at Birmingham, have found that when a person develops diabetes and their blood glucose levels rise, their body starts overproducing a protein called TXNIP. Research has shown that an excess of TXNIP in beta cells triggers a process of cell death, which of course makes it even harder for the body to regulate blood glucose effectively.

The research team then started to search for drugs that could help reduce TXNIP in beta cells. And they found that verapamil, which is widely used in the treatment of high blood pressure, irregular heartbeat and migraine headaches, fitted the job description.

Working with mice with diabetes, the team found that the drug was very effective – not just halting beta cell decline, but actually restoring the mice’s ability to make their own insulin. The team have planned the new clinical trial to find out if the drug can have a similar effect in people with type 1.

There is no current treatment for diabetes that targets beta cell growth and development in this way, so if the results of this trial are positive, it might establish a completely new treatment paradigm for type 1 diabetes.

This trial will be a stepping stone to see if the approach can work. In the best case scenario, this trial would see beta cell mass completely restored in all the people taking the drug in the study. This is unlikely – but a more subtle effect would still be very beneficial explains Dr Shalev: 'We know from previous large clinical studies that even a small amount of the patient’s own remaining beta cell mass has major beneficial outcomes and reduces complications. That’s probably because even a little bit of our body’s own beta cells can respond much more adequately to very fine fluctuations in our blood sugar — much more than we can ever do with injections or even sophisticated insulin pumps.'

The announcement of this clinical trial goes to show how important detailed ‘basic science’ studies in the lab can be – a thorough understanding of beta cells biology is what has made this trial possible. JDRF is proud to have supported the lab science that has got us to this point, and to be providing the funds for the clinical trial that will test whether the approach can work in people.

Karen Addington, Chief Executive of JDRF in the UK commented 'Repurposing existing drugs to address the fundamental challenges of type 1 diabetes – in this case the loss of the beta cells which make insulin - is a smart approach. Years of work in the lab to understand how beta cells work has allowed scientists to identify a target and then search out existing drugs that act on it. This trial will now allow us to see if the positive findings in animals can translate into humans. We eagerly await the results.’


Breaking news: Encapsulated stem cells implanted in to person with type 1 diabetes for first time

JDRF partner company ViaCyte has announced the first successful implant of its islet encapsulation system into a person with type 1 diabetes. The person was taking part in a University of California-based trial to assess the safety of the system.

Type 1 diabetes arises when the body’s immune system attacks and destroys the insulin-producing cells of the pancreas, leaving a person with type 1 unable to manage their own blood glucose levels without external sources of insulin. ViaCyte’s system replaces these insulin-producing cells, and could therefore allow a person with type 1 to produce their own insulin automatically in response to changing glucose levels.

The device, called VC-01, contains thousands of immature cells derived from stem cells in a credit card-sized capsule. Once implanted inside the body, these cells mature into insulin-producing cells and are kept safe from the immune system. This protection sets the treatment apart from traditional transplantation, where the cells are left unprotected and are eventually destroyed once again by the immune system.

Because the system uses stem cells, it also has the potential to treat far more people than transplantation, which is hampered by a lack of organ donors. Indeed, just two weeks ago, Dr Doug Melton, who has also received JDRF funding, announced an efficient method of producing thousands of insulin-producing cells from small numbers of stem cells in the lab.

However, the University of California trial is just the first of many that will be needed to see if the treatment is a success. The primary goal of this first study is to evaluate the safety of the VC-01 device in people who have had type 1 for at least three years, not to make them insulin independent. Subsequent trials will be needed to see how effective the device is over a number of years.

‘I’m really excited that this encapsulation system is being tested in a person with type 1 diabetes,’ said Karen Addington, CEO of JDRF in the UK . ‘Islet encapsulation has huge potential to transform the lives of people with type 1 – which is why we’re proud to support this and many other encapsulation projects around the world.’

Dr. Paul Laikind, President and CEO of ViaCyte, said: ‘Treating the first patient with our stem cell-derived islet replacement product candidate is an exciting next step in our quest to transform the way patients with type 1 diabetes are impacted by the condition.  Moving from a promising idea to a new medicine is a long and challenging journey and we are grateful to JDRF, and all its supporters, for the tremendous and continued support they have provided.’


Dr. Melton – the Harvard hero behind today’s type 1 diabetes stem cell breakthrough – thanks JDRF

You’ve seen the news today. Harvard stem cell researchers have announced a ‘giant leap forward’ in the quest to find a truly effective treatment for type 1 diabetes. 

With human embryonic stem cells as a starting point, the scientists are for the first time able to produce – in massive quantities – human insulin-producing beta cells equivalent in almost every way to normally functioning beta cells. It’s not yet a cure. But it’s big news.

Now meet the man who led this breakthrough.

Dr. Doug Melton is Co-scientific Director of the Harvard Stem Cell Institute. When his then-infant son Sam was diagnosed with type 1 diabetes 23 years ago, he dedicated his career to finding a cure for the condition. His daughter, Emma, also lives with type 1 diabetes.

The 61-year-old Cambridge graduate has previously been listed among TIME magazine’s 100 most influential people in the world. Jose Oberholtzer, Associate Professor of Surgery, Endocrinology and Diabetes and Bioengineering at the University of Illinois said: “Doug Melton has put in a life-time of hard work in finding a way of generating human islet cells in vitro. He made it.”

When he told his son and daughter about his breakthrough, they were surprisingly calm. He said: “I think like all kids, they always assumed that if I said I’d do this, I’d do it.”

Melton is now beginning a US$4 million project with JDRF, for the next stage of development of these cells. Expressing gratitude to the charity and its supporters, Dr. Melton said: “their support has been, and continues to be essential.”


JDRF’s #WalktoCure Diabetes raises over £285,000 – and counting

JDRF’s #WalktoCure Diabetes season is now over – but the money raised is still coming in. Thank you to everyone who participated in our walks, raising over £285,000 of an expected £330,000 so far!

Over the month of September, supporters from across the country came out in their thousands for JDRF. Step by step they tweeted their stories and fundraised tirelessly – helping to support vital type 1 diabetes research along the way.

Hornchurch mum Sarah Vincent took part in the London Bridges Walk yesterday. She said: “A big thank you to everyone at JDRF for a lovely day! My nine year old son was diagnosed with type 1 diabetes nearly a year ago and like a lot of other families, we have good days and bad days.

“But today was a good day – the sun was shining and it was great to see so many people at the walk, raising money to help find a cure for the condition.”

Hayling Island Walk participant, Nikki Johnson, said yesterday: “I’m here in memory of my grandad Derek, who lived with type 1 diabetes for over 60 years. He did a lot for JDRF and inspired many people along the way. It’s great to be united with other people fighting for the same cause.”

JDRF’s #WalktoCure Diabetes events take place in various countries around the world – so those that took part in the UK  stood shoulder to shoulder with hundreds of thousands of people who have walked in support of type 1 diabetes research globally.

Lydia Warrilow, Head of Regional Fundraising at JDRF said: “Our annual walks are a great opportunity to meet other families affected by type 1 diabetes. Thank you so much to all of our walkers, for supporting JDRF and raising such a remarkable amount of money.”

Walk season is over but the fun doesn’t have to finish. Wear a onesie to school or work and be a #TypeOnesie for JDRF this World Diabetes Day!


A view from Vienna, day 5: Looking to the future

This week, Conor McKeever (our Research Communication Officer) is reporting from the European Association for the Study of Diabetes (EASD) conference in Vienna. Each day he'll be reporting on the things he's found interesting and exciting from Europe's biggest meeting of diabetes researchers.

Although things were winding down in Vienna, Friday was definitely a case of last but not least for type 1 research. Potential cures were at the forefront of the day’s lectures, with a particular focus on encapsulation and immune therapies – two big areas in which JDRF is investing.

Stanley Lasch, from the Goethe University Hospital in Frankfurt, announced the results from a study that combined two immune system treatments to make one more effective therapy. Current research into anti-CD3 drugs (which target the immune system T cells involved in type 1) has found that they can help reduce a person’s need for insulin, but that the effect wears off fairly soon after, allowing the T cells to return. Lasch’s team looked at adding a second drug that they believe can prevent T cells getting back into the pancreas after the anti-CD3 drug wears off.

Overall, 65% of the mice given the two drugs did not require insulin after six months; in contrast, 47% of the mice given anti-CD3 drugs alone did not require insulin after this time. Although research is needed to see if the effect can be replicated in humans, it’s an exciting step forward for a treatment that’s already receiving a lot of interest.

Dr Gerlies Treiber, of the Medical University of Graz, was also enthusiastic about a possible immune therapy for type 1. She has been investigating the effects of vitamin D on the immune system, as low vitamin D levels are one of the factors being studied as a potential contributor to type 1 risk. She found that giving vitamin D supplements to people who were newly-diagnosed with type 1 seemed to increase the activity (though not the number) of their regulatory T cells – the cells that are meant to stop the immune system attacking the body. Given that this defence appears to fail in type 1, increasing the strength or number of regulatory T cells is one aim of our cure research.

On the encapsulation side of things, Dr Evi Motté from the Diabetes Research Center in Brussels has been studying the effectiveness of the cells used in ViaCyte’s macro-encapsulation device. We recently announced how the company, which has received JDRF funding, now has approval to test their device in humans, so it was particularly pleasing to hear that other researchers are testing the cells ViaCyte use.

Motté found that the macro-encapsulated cells were able to secrete a much higher level of insulin than cells implanted using more traditional micro-encapsulation techniques. Levels were more similar to the levels found in non-protected transplanted cells, but non-protected cells are still vulnerable to attack from the immune system, so fail more quickly.

On the whole, the last day of the conference showed there is a lot of hope for cure research. Immune therapies and encapsulation work is coming on apace, and it’s really encouraging to see that researchers from around the world are getting behind the same work that JDRF is supporting. In fact, I’d say the same was true of the week as a whole – there’s so much tremendous research going on and there was barely a session that didn’t have JDRF-supported work somewhere in it. It’ll be great to see where the research goes from here, and I’m excited to see what will be announced at next year’s conference in Stockholm.

Photo: Vienna by Flickr user Miroslav Petrasko, used under a Creative Commons licence.


Motoring fan? Up for a challenge? Do Scumrun 2015 across Europe for JDRF and support type 1 diabetes research!

A famous four-day charity car rally across Europe has selected JDRF as its charity for 2015.

UK motoring fans will hit the continent’s roads in May for the 10th anniversary Scumrun event. Scumrun is a ‘charity drive,’ which sees participants drive old cars – that must be under £500 in value – onto a ferry from a UK port and then on to the roads of western Europe.

The event, which sees people staying on campsites, has a big reputation for fun and for humour.

Participants are encouraged to decorate and modify their cars while getting behind the wheel in wacky outfits. Prizes up for grabs include the ‘Spirit’ of the event, ‘Best Dressed’, ‘Best Modified Car’ and of course ‘Highest Fundraising Achieved.’  Participants’ sense of adventure is heightened as their designated route around Europe is not told to them until just before they set off.

In recent years, each Scumrun has had over 100 cars participate. The event has a proud record of raising funds for one lucky charity each year. In spring 2014, the charity Tommy’s benefited to the tune of £100,000.

Karen Addington, Chief Executive of JDRF in the UK, said: “JDRF is incredibly excited to be chosen as the charity for the 2015 Scumrun charity drive. Type 1 diabetes affects 400,000 people in the UK – including 29,000 children. But finding a cure for this condition is just a matter of time, money and great research. The support of Scumrun will help us travel further along the road to the cure.”

Are you a motoring fan who wants a road adventure this spring? Do you want to support type 1 diabetes research that will make a difference for children and adults living with the condition? Click here to register for this major JDRF fundraising event.


A view from Vienna, day 4: type 1 tech and treatments

This week, Conor McKeever (our Research Communication Officer) is reporting from the European Association for the Study of Diabetes (EASD) conference in Vienna. Each day he'll be reporting on the things he's found interesting and exciting from Europe's biggest meeting of diabetes researchers.

It’s hard to believe that the JDRF Artificial Pancreas Program was launched only eight years ago. Since then, we’ve gone from a few prototype devices being used by one or two people, to three-week and three-month trials of the artificial pancreas at home, unsupervised by researchers.

But as exciting and as close to reality the first generation devices are now, we’re not resting on our laurels. Thursday’s presentations from researchers focused on all elements of the artificial pancreas – CGMs, pumps and the algorithm – and how we can get the most from them.

Dr Hood Thabit and Dr Martin Tauschmann, both working as part of the University of Cambridge artificial pancreas team, were among those in Vienna to share their results.

They’ve found that using the artificial pancreas overnight helps people to bring their glucose levels down, without increasing the risk of hypos – a success that we’ve previously reported on. They’re also looking at why some people do better than others on the trials, to see what can be done to improve the efficacy of the device. At the moment, according to Dr Tauschmann, the longer a person has had type 1, the less time they spend in the target blood glucose range when using the artificial pancreas. If the researchers can establish why this is, they will use that information to make the device even better than it is currently.

Dr Thabit also discussed a CGM accuracy trial that had supported their decision to allow the artificial pancreas to be used at home. It was no small undertaking, taking the equivalent of 2,002 days’ use (nearly 5 ½ years!) for the CGMs being used to be deemed accurate enough. This, if anything, made it clear that the researchers are dedicated to making the best artificial pancreas system possible.

Later, we heard from Dr Roberto Trevisan of the Papa Giovanni XXIII Hospital in Bergamo, Italy, who has found that using insulin pumps can help people with type 1 avoid complications. Dr Trevisan’s trial suggested that even when blood glucose levels were similar to those of people using insulin injections, using a pump reduced the risks of kidney problems.

To round off the day, Professor Eric Renard, of the University of Montpellier, gave his opinion on whether ‘the dream’ of an artificial pancreas could ever become reality. Drawing together the histories of CGMs and pumps, from the unwieldy and inaccurate devices of the 70s and 80s, to the increasingly complex simulators of the last few years that have allowed the two devices to work together, he made it clear he believes the artificial pancreas is closer than ever.

“Closed loop insulin delivery at night is already safe, effective and sustainable in the home, while 24/7 use is feasible, with several trials ongoing,” he concluded.

Photo: Vienna by Flickr user Krister, used under a Creative Commons licence.


A view from Vienna, day 3: trying to make type 1 diabetes complications less complicated

This week, Conor McKeever (our Research Communication Officer) is reporting from the European Association for the Study of Diabetes (EASD) conference in Vienna. Each day he'll be reporting on the things he's found interesting and exciting from Europe's biggest meeting of diabetes researchers.

While a lot of the research we fund at JDRF is working towards a cure, we also want to help people who have type 1 to live longer, healthier lives until the cure is found. That’s why we fund a number of projects looking at preventing and treating complications, alongside work to make controlling glucose levels safer and easier. And from Wednesday’s sessions at EASD it’s clear we’re not alone in this: researchers from around the world were here to discuss their work on understanding diabetes complications.

A lot of the studies presented today focused on understanding what causes complications – if we can understand this, we may be able to develop strategies to address these root causes before complications develop.

Stijn Peeters, from Maastricht University, is focusing on the extracellular matrix (ECM) – essentially, the space between the body’s cells, and the molecules that are found there. He has found that people with type 1 tend to have higher than normal levels of molecules that break down the ECM. He also discovered that having high levels of some of these molecules is associated with conditions like retinopathy and cardiovascular disease. Although these molecules are part of the body’s way of getting rid of old and damaged parts, it seems like having too many could indicate a higher risk of complications. Knowing this, researchers may be able to identify steps we could take to reduce that risk.

Other researchers looked at different complications.  A team from Manchester led by Dr Steven Brown looked at the effect of diabetic neuropathy on something that on the surface doesn’t come up much in conversations about diabetes – falling down the stairs. People with nerve damage to their limbs had greater trouble balancing when going up and down stairs than people without this nerve damage. The team are now working to understand whether strength training and other interventions can help mitigate this risk for people who do develop nerve damage.

Being able to diagnose complications early is a key goal for many researchers. Dr Vincent Monnier of Cape Western Reserve University announced how his team had been able to link the fluorescence of collagen in the skin to a person’s risk of retinopathy and kidney disease. It certainly seemed like a novel way to test for a person’s risk of these conditions, and new ideas like this are incredibly important for the future.

The fact that getting the best possible glucose control is still the best way to reduce risk of complications seems to be reinforced by a study from Sweden looking at difference in rates of complications between people using insulin pens and those using pumps – the pump group were 43% less likely to develop fatal cardiovascular disease than the group using pens. The authors were rightly careful to highlight that pump usage alone probably doesn’t account for all of this risk reduction. Other important factors, such as the intensive education people in Sweden receive when they go on a pump, are likely to play an important role in the difference between the two groups. Unpicking these factors, and deepening our understanding of how to detect and treat complications if they do arise, mean that we can look forward to a future where complications of diabetes are less, well, complicated!

Photo: Park in Vienna by flickr user Ville Miettinen, used under a Creative Commons licence.


A view from Vienna, day 2: Education, education, education

This week, Conor McKeever (our Research Communication Officer) is reporting from the European Association for the Study of Diabetes (EASD) conference in Vienna. Each day he'll be reporting on the things he's found interesting and exciting from Europe's biggest meeting of diabetes researchers.

Tuesday was the first day of the conference proper, with scientific presentations and announcements beginning in earnest.

In the morning, talks chaired by Professor Simon Heller of the University of Sheffield emphasised the importance of diabetes education – something that JDRF is also committed to highlighting. Just last week we led the latest All-Party Parliamentary Group for Diabetes meeting, focusing MPs' attention on the results of our recent tweetchat on diabetes education.

With researchers from the US, Germany and Italy announcing how their education programmes have helped lower HbA1c levels, reduce the frequency of hypos, and improve overall control, this should make it harder for the Government to ignore.

One of the more unusual talks came from Professor Daniel Cox, of the University of Virginia, about a novel way to reduce the risk of 'mishaps' while driving. He trialled an online tool that assessed whether people were at high risk of accidents (for example, if they were less likely to test their levels before driving, or often had hypos on the road), then guided them through modules to develop safer behaviours (such as instilling a pre-driving routine that included a blood test, and how to prevent hypos while driving). He even developed a 'pre-drive checklist' – like a pilot’s pre-flight checklist – to help.

Overall the tool led to a 53% reduction in the number of 'mishaps', bringing the high-risk drivers to a level much closer to that of the low-risk drivers. This success suggests that educational programmes like these can sit alongside traditional systems that aim to reduce HbA1c.

Unfortunately, this may become harder to implement as driving regulations change: research from the University of Copenhagen also announced at the conference suggested that when EU regulations changed in 2012, people began under-reporting hypos to avoid losing their licence. By not reporting this information, these people could then be missed out if their healthcare teams come to offer advice around driving.

More worryingly, if there is a wider trend of people under-reporting hypos, people with type 1 could be missing out on crucial help more generally. Education can help people improve their management, but only if healthcare teams know what help to give, and to whom. The results from the Copenhagen team are concerning and we should try to identify if this is a widespread effect, and take steps to prevent it.

Photo: Vienna Square by Flickr user celesteh, used under a Creative Commons licence.


A view from Vienna, day 1: Discussing infant diet and risk of type 1 diabetes

This week, Conor McKeever (our Research Communication Officer) is reporting from the European Association for the Study of Diabetes (EASD) conference in Vienna. Each day he'll be reporting on the things he's found interesting and exciting from Europe's biggest meeting of diabetes researchers.

On Monday, JDRF held a discussion that drew in experts from around the world. Entitled ‘The Role of Infant Diet in Susceptibility/Resistance to Type 1 Diabetes’, it looked for answers to a big question in type 1 diabetes research – can we run a study to explore the influence that a child’s diet has on their risk of developing the condition?

We already fund a number of studies in this area, the largest of which is TEDDY (The Environmental Determinants of Diabetes in the Young), which is following over 8,000 children over several years to see if there is an identifiable ‘trigger’ that could prompt them to develop type 1. However, because these studies take a number of years to complete, it is important for us to hear from experts in the field before embarking on a new project.

Professor Mikael Knip, whose research we reported on in July, is enthusiastic that a large scale prevention project is possible. He is looking at the role of baby formula in type 1, and has so far found that using a special kind of baby formula does not affect the development of the early indicators of type 1.

His opinion is shared by Professor Annette Ziegler, who is involved in the BABYDIET study. She has found that introducing gluten into a child’s diet at either 6 months or 12 months makes no difference to early indicators of type 1. However, Professor Ziegler pointed out that it is very difficult to make sure that people in a study follow the trial diet, or accurately report their diets, over many years – a difficulty that would need to be overcome in any future studies.

Despite these reservations, many of the researchers had found clinical studies such as TEDDY helpful in their work. Some had used its data to look at the role of gluten and coeliac disease, while others looked at probiotic use – without TEDDY, both of these investigations might have required separate, expensive trials that would not have recruited as many people.

There was also a lot of discussion about an up-and-coming area in type 1 research – the role of the ‘microbiome’, or the bacteria that live inside us. Professor Dusko Ehrlich of King’s College London pointed out that the total number of genes from these bacteria is 150 times bigger than the human genome, so we can’t afford to discount them, and early indications are that the bacteria in our gut can influence the development of type 1.

Given these opinions, it looks as though research into infant diet is going to continue to play a role in type 1 research – and that the microbiome is likely to become an increasingly important part of this work.

Photo: Sunset over Vienna by Flickr user cadoc, used under a Creative Commons licence.


Promising new drug for diabetic retinopathy hits clinical trials

A completely new treatment for diabetic retinopathy has started being tested in people for the first time. The first-in-man trials of experimental drug KVD001 began this month, focussing on assessing the safety and tolerability of the drug in treating diabetic macular oedema (a particular type of retinopathy).

The trials are being conducted at the world renowned Beetham Eye Institute (part of the Joslin Diabetes Centre at Harvard Medical School in Boston) and recruitment will gradually roll out through five centres in the US.

The company behind the drug, KalVista, is a small biotechnology company based near Southampton. JDRF has been working with KalVista on the drug for a number of years, and indeed JDRF supported the academic research that identified the biological pathway the drug is designed to target.

The only drug currently licensed specifically for treating diabetic macular oedema, is ranizumab (brand name Lucentis). This drug is designed to target a molecule called vascular endothelial growth factor and so prevent the disordered growth of blood vessels that contributes to vision loss. While treatment with Lucentis has been able to help many people with diabetic macular oedema, it doesn’t work for everyone. KVD001 is a type of molecule called a plasma kallikrein inhibitor, and targets a different biological pathway to Lucentis – so KalVista’s new drug may be able to help those for whom Lucentis does not work.

Rachel Connor, Head of Research Communication at JDRF in the UK said: ‘As complications of living with type 1 go, vision loss is one of the most feared. JDRF’s research strategy prioritises work to understand diabetic retinopathy and devise new ways to treat and prevent it for exactly this reason. So we’re excited to see KVD001, a drug that we have helped Kalvista to develop, make it to the first phase of clinical testing. There is of course still a long way to go, but if this treatment works it will provide a new option for people who develop diabetic macular oedema.'

Read more about JDRF’s work to help treat type 1 diabetes and its complications and find out how you can help to support research projects like this.


Behind the headlines: “Diabetes could be cured as scientists find cause of disease”

Today the Telegraph, and other news outlets, covered a story about research from the universities of Manchester, UK and Auckland, New Zealand discussing the role amylin may play in beta cell death.

What is the story all about?

The news story focuses on new research surrounding the hormone amylin published in the Journal of the Federation of American Societies of Experimental Biology. Amylin is another hormone produced by pancreatic beta cells alongside insulin. But because beta cells produce approximately 100 times as much insulin as they produce amylin, this hormone was only discovered in 1986 (we’ve known about insulin since 1921). Amylin’s role in the body is associated with gastric emptying and satiety (feeling full after eating), but it has also been shown that amylin can build up in large deposits in the pancreases of people with type 2 diabetes, and these deposits are thought to trigger the death of beta cells. This story focuses on the role of amylin in beta cell death.

What did the scientists do in their study?

To investigate what happened when too much amylin built up in the pancreas, the scientists worked with mice that were genetically modified to have pancreatic beta cells that over-produce amylin. They had two groups of mice that overproduced amylin at different rates: ‘homozygotes’ that expressed very high levels of amylin, and ‘hemizygotes’ that produced about half as much amylin, but still far more than would usually be made by a beta cell.

They then did a number of tests to monitor what happened to the mice. The homozygotes quickly developed diabetes and the scientists could see that the beta cells quickly disappeared. The scientists likened the rapid progression to diabetes as being similar to type 1 diabetes. The hemizygotes, progressed to diabetes much more slowly, so the research team likened this to type 2 diabetes.

The team examined how the amylin produced by the cells behaved in the pancreas to find out which aspects of amylin overproduction might be involved in driving beta cell death. They found that there was a marked difference in the way the cells responded to extreme overproduction as compared to overproduction, but in both cases, amylin overproduction led to diabetes and beta cell loss. This shows that the build up of large deposits of amylin as previously observed in type 2 diabetes, is not the only mechanism by which amylin can influence beta cell death.

What does this mean for people with type 1 diabetes?

Although the headline of the Telegraph claims the cause of diabetes has been found, this claim is not made by the authors themselves. They suggest that it is possible that amylin overproduction might have a role in a subset of cases of type 1 diabetes, and that this would be an interesting avenue for further investigation.

This study is primarily interesting to people involved in type 1 research because it indicates that amylin may have a role in driving beta cell death – but this is still likely to be a result of disrupted beta cell function. So it may be that by targeting the pathways through which amylin drives beta cell death we could develop treatments that protect beta cells from destruction. But there is still a great deal of work to be done in understanding the role of amylin in beta cell death in type 1 diabetes before it is likely to lead to new ways of treating type 1 diabetes in the clinic.

Is any other research on amylin taking place?

Yes. When type 1 diabetes develops, beta cells are destroyed, so as well as losing the ability to produce insulin, people with type 1 also lose the ability to produce amylin. As part of our research treatment research strategy, JDRF has supported work to understand if giving people with type 1 a synthetic form of amylin, called pramlintide, alongside their insulin, might help in achieving good glucose control. These studies are ongoing and we await the results with interest. 


Bubbling with excitement – new encapsulation trial for type 1 diabetes is step towards life without injections

This week saw a big milestone in type 1 diabetes research: approval was given for the first human trials of a ‘macroencapsulation device’ filled with stem cells programmed to become insulin-producing cells.

JDRF has been working with US company ViaCyte for a number of years to support the development of a product that could transform the lives of people with type 1, by providing a way for them to produce insulin ‘on demand’ without pumps or sensors.

The product is designed to work by giving people a stock of immature cells that are programmed to develop into insulin-producing cells. These are contained within a physical device that can be implanted into the body and acts as a protective bubble to keep the new cells safe from immune attack.

The announcement means that Viacyte can start testing the device in people with type 1 for the first time – so far the system has only been tested in animals. The first trials will primarily focus on making sure that the device is safe and causes no ill effects, but will also measure how well the cells are able to produce insulin.

Karen Addington, Chief Executive of JDRF in the UK said: ‘I’m really excited to see this innovative product moving into clinical trials for the first time. JDRF has made supporting encapsulation research a priority because we believe this approach could free people with type 1 from the physical and mental burdens of testing, carb counting and injecting or pumping insulin that are currently the norm.

'We look forward to seeing results from this trial, and progress in other encapsulation projects around the world.’

Read more about encapsulation research, and find out how you could support innovative research projects like this.