Could inflammation at diagnosis help us work out who would benefit from new treatments?

Posted on 07 September 2018

Woman in striped top injecting insulin into her side

A study has found that inflammation levels at diagnosis are linked with how quickly type 1 diabetes progresses.

Inflammation in this context refers to immune system activity targeting the insulin-producing beta cells in the pancreas.

Higher levels of inflammation at diagnosis resulted in faster loss of natural insulin production.

In their paper, the researchers say that their results support the existence of multiple subtypes of type 1 diabetes.

This will help researchers to identify who is most likely to benefit from future treatments designed to stop the immune system attack on the beta cells and preserve insulin production.

The study was partly funded by JDRF.

Why did they do this research?

We know that type 1 diabetes progresses at different speeds in different people. For example, people who are diagnosed with type 1 diabetes as children tend to have a more aggressive form of the condition than those diagnosed as adults, and lose their ability to produce insulin faster.

This means that people have been responding differently to new treatments for preserving insulin production being tested in clinical trials, making it harder to work out if a new treatment is indeed effective.

Over the years, researchers have tried to specify different subtypes of type 1 diabetes to explain these differences, and to work out who would benefit most from new treatments. In this study, the researchers wanted to see if inflammation levels at diagnosis could be linked with how quickly someone loses the ability to produce insulin.

What did they find?

The team analysed blood samples from 42 children recently diagnosed with type 1 diabetes in the US. The researchers also studied existing blood samples collected as part of the TrialNet programme.

People who had higher levels of inflammation at diagnosis lost their ability to produce insulin faster than people with lower levels of inflammation at diagnosis.

The team identified four subgroups of people who had different forms of type 1 diabetes, based on the different inflammation patterns at diagnosis.

What does this mean for type 1?

These findings highlight that type 1 diabetes is not a one-size-fits-all, and people experience different forms of the condition.

The researchers hope that their results will help to work out who would benefit the most from future treatments:

“The ability to identify individuals with rapidly progressing [type 1 diabetes] would allow for more informative and targeted trials of participants most likely to benefit from therapeutic intervention.”

What’s the next step?

The researchers have called for further studies to see whether the subgroups of type 1 diabetes identified in this work are seen in other groups of people.

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