Primary prevention

To prevent type 1 diabetes before it has begun, we must be able to first identify people at risk of the condition. Thanks to research, much of it funded by JDRF, we now know a great deal about the genetic factors that can influence risk of type 1 diabetes, but we don’t yet know why some people with the same genetic risk factors go on to develop the condition, while others do not.

The first step in working out how to prevent a condition is to work out how it begins in the first place. Researchers have been working hard for many years now to understand the natural history of type 1 – what happens in someone’s body before they start needing insulin.

Genetic factors

We now know of more than 50 genes that have an influence on the risk of developing type 1. We know that some variations of these genes make it very likely someone will get type 1, while others only increase risk slightly on their own, but in combination with others could play a much more significant role.

We, in partnership with the Wellcome Trust, are supporting one of the world-leading teams in type 1 genetics here in the UK. The JDRF/Wellcome Trust Diabetes and Inflammation Laboratory which has now moved to Oxford University, is led by Professors John Todd and Linda Wicker, and their painstaking work has led to many exciting insights into the development of type 1, from providing genetic clues as to how viruses may trigger type 1 to understanding the links between type 1 and other autoimmune conditions, like coeliac disease. Professor John Todd is continuing this work to identify the causes of type 1 diabetes and autoimmunity which began in October 2015.

Environmental triggers

Islets responding to virus - Sarah Richardson
Islets responding to a viral infection

The possibility that viruses may have a role in triggering type 1 is also being explored by Dr Sarah Richardson at the University of Exeter. Her work has shown that a many more pancreas samples from people recently diagnosed with type 1 show evidence of viral infection than comparative samples from people who did not have type 1. If a particular virus can be shown to be an important cause of type 1 diabetes, we could potentially develop a vaccine against it that could be given alongside other childhood vaccinations, preventing many cases of type 1 at a stroke.

Another relatively new theory is that a person’s risk for type 1 diabetes is increased by an imbalance in the ‘microbiome’, the types of bacteria that are present in the gut. So another avenue of primary prevention research that we are exploring is whether particular bacterial populations in the gut can really make it more or less likely that someone will develop type 1. And if this is the case, is there a way to treat people at high risk of type 1 so that their own gut bacteria can protect them, rather than put them at risk of developing the condition.