#28 - Why T1D hits young children harder 🔬

Hey readers! 🌟

This week brings a fascinating mix of research insights and real-world progress in T1D care. From understanding why the condition hits young children harder to seeing how technology continues to evolve, there's plenty to dig into.

Scientists have discovered a crucial piece of the puzzle explaining why type 1 diabetes progresses so much faster in young children compared to adults. The research, published in Science Advances, reveals that beta cells in young children exist in smaller, more vulnerable clusters that are easily destroyed by the immune system before they can mature into the larger, more resilient groups found in older individuals. This finding fundamentally changes our understanding of disease progression and opens doors for new immunotherapy approaches.

The implications are significant. By understanding that these tiny insulin-producing clusters are the key vulnerability, researchers can now focus on protecting them early in the disease process. This could lead to treatments that delay onset or preserve more beta cell function, potentially giving children years without insulin therapy. The research team at the University of Exeter emphasizes that these small clusters, once overlooked, hold major clues for developing screening programs and preventive strategies.

Breakthrough T1D has outlined its comprehensive strategy for eliminating the burden of type 1 diabetes through three complementary pathways: cell therapies, early detection, and disease-modifying therapies. The organization currently funds an impressive portfolio of 117 preclinical and 5 clinical cell therapy projects, 52 preclinical studies and 26 early detection trials, plus 138 preclinical and 16 disease-modifying therapy trials.

Their Project ACT initiative focuses specifically on developing scalable, immune-protected cell replacement therapies that don't require broad immunosuppression, addressing one of the biggest barriers to making cell therapies accessible to everyone who wants them. Meanwhile, advocacy efforts like the SCREEN for Type 1 Diabetes Act aim to expand early detection programs, and work to standardize C-peptide as a biomarker promises to accelerate the development and approval of new disease-modifying therapies.

A clinical trial led by researchers from the University of Calgary and Sinai Health demonstrates that automated insulin delivery technology significantly improves glucose control during pregnancy for people with type 1 diabetes. The hybrid closed-loop system resulted in a statistically significant increase in time spent in the desired glucose range compared to standard insulin injections or non-automated pumps, with additional benefits including lower average blood sugar, more stable levels, and fewer episodes of hypoglycemia.

This finding provides important evidence for pregnant individuals or those planning pregnancy about the concrete benefits of automated insulin delivery systems, potentially leading to improved outcomes for both mothers and newborns during this critical period.

The 51st Annual ISPAD Conference in Montreal showcased several important developments. The PETITE-T1D study is investigating whether Tzield, which has been shown to delay T1D onset by an average of three years in older individuals, can benefit children under eight with stage 2 T1D. Preliminary data shows similar safety profiles to older populations, which is encouraging news for expanding access to this disease-modifying therapy. – Brian Herrick

The conference also reinforced that automated insulin delivery systems consistently improve outcomes and should become the standard of care worldwide for children with T1D. Researchers emphasized the need for more clinical trials focused on stage 3 T1D to preserve beta cell function, which can improve glycemic control and serve as a bridge to future therapies.

Breakthrough T1D has demystified the complex process of bringing new treatments and devices from concept to reality, using automated insulin delivery systems as a prime example. The organization's unique role spans the entire pipeline, from funding early research to advocating for regulatory approvals and insurance coverage. – Sandy Vogt, Ph.D.

This comprehensive approach has significantly shortened development timelines, demonstrating how strategic investment and advocacy can accelerate innovation that directly improves lives.

Smart Insulin Development: UCLA researchers have developed I-insulin, a novel formulation that includes a glucose transporter inhibitor to prevent hypoglycemia by regulating glucose entry into cells. In animal tests, it maintained normal glucose levels for up to 10 hours and shows promise for alternative delivery methods like patches or pills.

BARICADE Trials Launch: St Vincent's Institute research has led to global Phase 3 trials testing baricitinib in people with both pre-symptomatic and newly diagnosed type 1 diabetes across 20 countries, building on the success of the BANDIT trial.

Stem Cell Advances: Research published in PubMed shows that SPARC-modified mesenchymal stem cells significantly promote beta cell recovery and insulin secretion by improving calcium ion homeostasis, with promising results in diabetic animal models.

T1D Exchange shared stories from team members whose personal connections to T1D, whether through their own diagnosis or as caregivers, have shaped their career paths and fueled their dedication to improving lives. These narratives highlight how lived experience with T1D often leads to career shifts emphasizing healthcare, research, and community support.

The Juicebox Podcast featured Robin's journey to an islet cell transplant at the University of Chicago, where she became insulin-independent after managing type 1 diabetes for years. Her story offers valuable insights into the emotional and practical challenges of living with diabetes and the transformative potential of innovative treatments. – Scott Benner

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