Two different treatments for two different variations of type 1 diabetes?
In further tests researchers looked at blood samples taken from 171 people who had been diagnosed with type 1 diabetes before they reached the age of 30.
They found the same pattern: people fell into one of the two categories, depending on how well their pancreases made insulin.
Researchers concluded that these categories seem to correspond with age.
The findings suggested that people whose type 1 diabetes involved poor insulin production and a stronger immune attack tended to be younger.
Dr Richardson calls this group “endotype 1” in the study and added: “Pretty much everyone under the age of seven falls into this category.”
People diagnosed when they were 13 or older tended to fall into the “endotype 2” category - whose pancreases had fewer immune cells.
Those aged between 7 and 12 when diagnosed could fall in either category.
Dr Richardson said: “The outcome is the same – they both need insulin – but they may have got there through a different pathway.”
She added that the two types may respond better with different treatments in the future.
For example, people with endotype 2 could benefit from treatment that preserves the pancreas cells that make insulin.
However, such a treatment does not exist at present.
The study concluded: “Among those with type 1 diabetes diagnosed under the age of 30 years, there are histologically distinct endotypes that correlate with age at diagnosis. Recognition of such differences should inform the design of future immunotherapeutic interventions designed to arrest disease progression.”
Type 1 diabetes is currently treated with insulin, although researchers have been trialling new immunotherapies that kill the immune cells that attack the pancreas.
However, while clinical trials in adults have not been conclusive, Dr Richardson said the treatment might work better in younger children because immune cells seem to play more of a role in the condition.
In a 2018 study, DRWF-funded researchers based in Sweden and Finland proposed a new classification system for different types of diabetes with five different sub-categories, which could help healthcare professionals predict risk of serious complications and improve treatment suggestions.
These findings were based on age, body mass index, blood sugar, and insulin production and sensitivity.
Dr Richardson and her team said one of the endotypes seems to align with one of these five categories, but the other does not - which could make it possible that there could be six types of diabetes.
Professor Noel Morgan, of the University of Exeter Medical School, said: “We’re extremely excited to find evidence that type 1 diabetes is two separate conditions: T1DE 1 and T1DE 2. The significance of this could be enormous in helping us to understand what causes the illness, and in unlocking avenues to prevent future generations of children from getting type 1 diabetes. It might also lead to new treatments, if we can find ways to reactivate dormant insulin-producing cells in the older age group. This would be a significant step towards the holy grail to find a cure for some people.”
Support DRWF by making a donation here
Find out more about DRWF-funded research here
Find out more about DRWF fundraising here
To receive the charity’s latest bulletins as they become available, please sign up here
Read DRWF diabetes information leaflets here
Join the Diabetes Wellness Network here
I would like to make a regular donation of
I would like to make a single donation of