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Younger Children At Risk of Aggressive Form of Diabetes

Mar 5, 2016

Research finds differences in type 1 diabetes in children versus teens.

Due to the increasing occurrence of childhood obesity, younger people are being diagnosed more often with type 2 diabetes. However, younger children are at risk for a more severe form of type 1 diabetes than those in their teens. A new study from the University of Exeter observed that children who were diagnosed with diabetes under the age of six had far less insulin-producing cells left when compared to those diagnosed as teenagers. One of the lead authors who performed this ground-breaking research, Dr. Noel Morgan, said, “this is incredibly exciting, and could open the doors to new treatments for young people who developed diabetes. It was previously thought that teenagers with type 1 diabetes had lost 90 percent of their beta cells but…we have discovered that this is not true.”

Type 1 diabetes is a result of  “T-cell mediated destruction of pancreatic beta cells following the infiltration of leukocytes (including CD8+m CD4+, and CD20+) into and around pancreatic islets.”

Teens and children who develop diabetes are prone to a condition called “insulitis,” a condition where  just 5-10 percent of the islets of Langerhans become inflamed. Insulitis  is found in 70% of the children with recent onset diagnosis of diabetes. in nearly 70 percent of children with recent onset disease.The pathophysiology behind why islets become inflamed, why they target beta cells and how nearly 70 percent of meta cell mass is destroyed is still unclear. What is unique about the present findings is that since teens still manage to retain large numbers of beta cells (though not producing enough insulin), researchers can focus on potentially reactivating these cells so that they can continue to release insulin, or theoretically slow or even reverse the succession of the disease itself. In children, the greater focus is on insulin replacement since they essentially do not have enough beta cells to work with.

This new study shows the first clear evidence that children who are diagnosed with type 1 diabetes at the age of six years or under develop a more aggressive form of the disease. The study’s findings have a significant insinuation for this younger group of individuals. For instance, most clinical trials have been dedicated to focusing mainly on stopping the immune attack in older patients, where “insulitis” may be less detrimental. In the future, it will be important to assess whether younger children might benefit most from such approaches, as they have the more aggressive disease. Dr. Sarah Richardson — co-author of the study at the University of Exeter Medical School — was noted stating that, “For trials to be effective, we have to understand the underlying causes of the disease. Until now, most research into the onset of type 1 diabetes has been carried out in animal models. While that’s extremely valuable, there are clear differences in human pathology.”

This research is undoubtedly groundbreaking and an essential step forward in combating this horrific disease. Karen Addington, the UK Chief Executive of the type 1 diabetes charity JDRF, said: “A child diagnosed with type 1 diabetes at the age of five faces up to 19,000 insulin injections and 50,000 finger-prick blood tests before they reach the age of 18. But research can bring us closer to the day we find the cure.”

Practice Pearls:

  • Those with symptomatic type 1 diabetes onset as teenagers have more beta cells than dose diagnosed at six years or younger.
  • Younger children are at risk of developing more aggressive forms of diabetes.
  • Research now is focusing on potentially reactivating beta cells in teenagers in hopes of slowing the progression of the disease state.

Researched and prepared by Jimmy Tran, Doctor of Pharmacy Candidate LECOM College of Pharmacy reviewed by Dave Joffe, BSPharm, CDE

Greenwood, Beth. Diabetes Care Feb 2016 “Kids Differs From That in Teens.”  Web

Leete, Pia, and Noel G. Morgan. “Differential Insulitic Profiles Determine the Extent of Beta Cell Destruction and the Age at Onset of Type 1 Diabetes.” American Diabetes Association (2016): n. pag. Web. 12 Feb. 2016.

Veld, Peter. “Insulitis.” Diapedia.org. 03 Aug. 2014. Web. 12 Feb. 2016.