Delaying the need for insulin in people with pre-type 1 diabetes

Healthcare professionals discuss key areas in screening for new cases of type 1 diabetes.

Looking at what is being done to screen new cases of type 1 diabetes, especially in younger people, and what support is available to families in supporting management of a new diagnosis.

Claire Levy, PR and communications at DRWF, reported from the recent Diabetes UK Professional Conference held recently at the SEC in Glasgow.

This session was chaired by previously funded DRWF researchers Professor Kathleen Gillespie, Professor of Molecular Medicine, University of Bristol and Professor Susan Wong CBE, Professor of Diabetes and Metabolism and Honorary Consultant Physician in Diabetes, Cardiff University.

Professor Wong was recently awarded a Commander of the British Empire (CBE) for her outstanding services to diabetes and metabolism. 

A session on preparing for early detection and treatment of type 1 diabetes featured presentations from leading healthcare professionals in this field. Here we report on an update on managing screen-detected type 1 diabetes in young people.

DRWF-funded researchers Professor Kathleen Gillespie and Professor Susan Wong CBE, who chaired the session, with Claire Levy of DRWF

Professor Colin Dayan, Professor of Clinical Diabetes and Metabolism, Cardiff University School of Medicine, led a session talking about delaying the need for insulin.

Professor Dayan: “We've heard about the staging of type 1 diabetes. We know there are three stages now. We are going to talk a little bit about delaying onset. But before that just a reminder – this is not a metabolic condition. It is an autoimmune process with inflammation.

“The theory is very straightforward. If it is not a metabolic condition, if it is an autoimmune condition, then if we can slow or halt the autoimmune process, we can delay or avoid the need for insulin therapy.

“Moving towards being insulin-free does not mean you do not have an autoimmune disease, but it means you may not need insulin. To do that, you must look at the immune system.

“We now have lots of different drugs that can pick out small parts of the immune system much more safely than we used to.

“Currently in the UK we have zero immunotherapies licensed for type 1 diabetes. If you are working in rheumatoid arthritis, you are completely overwhelmed by the number of different therapies – more than 50 are available, oral therapies as well as injectables. Lots of other areas are using this, in asthma as well, using biologics and immunomodulation in a very safe way. Are there any that work in type 1 diabetes? And the answer is yes. And this is a list that is getting gradually longer.

“There is probably at least ten that have evidence at onset at stage three type 1 diabetes of slowing the autoimmune process. I am just going to talk about a couple of these. We are talking about intervention when you do need insulin.

“One example is golimumab (to treat colitis), an injection given as one dose every two weeks. I will also mention of verapamil (to treat high blood pressure) and baricitinib. The latter is licensed for rheumatoid arthritis. It was very widely used as it was also licensed for use in Covid. More than a million people have received this drug. We know an awful lot about the safety of it. How does it work? It acts on what are called Janus kinases, which are the signalling molecules, particularly around interferons, but other cytokines as well.

“The interesting thing about it is you might think it is an immune therapy, which it is in rheumatoid arthritis, but it has a particular advantage in type 1 diabetes – that it seems to affect the action of cytokines on the beta cell. In other words, it makes the beta cell less responsive to the inflammatory milieu. And it did work. Abatacept is another drug that is widely used in rheumatoid arthritis.

“One treatment is not necessarily enough. You have to combine them at different times and in different ways. We are certainly getting interested in the idea of combination therapies.

“We can see what the combined effect is to delay things for longer. And there are other combined therapies.

“I just want to conclude by talking about the impact of this. You could say we do not need new treatments. We have got all this kit. This is a wonderful piece of kit.

“We do need to monitor these people for progression, but not every day. It is not something you have to worry about day in and day out. And most importantly, they are not accruing a risk of metabolic complications. It is likely to reduce risks in the future of complications and improve quality of life for two years, which is a long period of time and potentially longer.

“My vision is that in the future we will not be managing insulin. We will be managing the immune therapies and adjusting this like our colleagues with other autoimmune conditions.”

A later diagnosis and a day less with type 1 diabetes

Preparing for early detection and treatment of type 1 diabetes

Managing screen-detected type 1 diabetes in young people