Type 1 Diabetes is 2 Distinct Conditions Defined by Age at Diagnosis 

Researchers propose two subtypes of type 1, T1DE1 and T1DE2; new findings could spur further research into whether dormant insulin-producing cells can be reactivated. 

New research has found that children diagnosed with type 1 diabetes mellitus under the age of seven have a different type (specifically “endotype”) of the condition when compared to patients with diabetes who have been diagnosed at age thirteen or above. 

A diagnosis of type 1 diabetes occurs when a patient’s immune system mistakenly destroys the insulin-producing islets of Langerhans cells in the pancreas. Thus, the pancreas produces little to no insulin, and the body is unable to regulate blood sugar levels effectively.  

The new study was conducted at the University of Exeter and published in Diabetologia. The research was funded by Diabetes UK and the Juvenile Diabetes Research Foundation (JDRF). What they found was that children diagnosed under the age of 7 do not process insulin properly, and the insulin-producing cells get destroyed rapidly.  However, older patients, aged thirteen and above, actually frequently continue to produce insulin. These revelations stand to reignite discussions over whether “dormant” insulin-producing cells themselves could be “reignited” to work effectively. 

The team from the University of Exeter has suggested names for the distinction between the two proposed sub-types of T1DM:  
Type 1 Diabetes Endotype 1 (T1DE1) for children who get diagnosed at a younger age, and Type 1 Diabetes Endotype 2 (T1DE2) for those who are older at diagnosis. 

Specifically, the study recommends that children diagnosed between the ages of 7-12 could fall into either the T1DE1 or T1DE2 category. 

Professor Noel Morgan from the University of Exeter explained: “We’re extremely excited to find evidence that type 1 diabetes is two separate conditions: T1DE1 and T1DE2. 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.” 

By studying the small amounts of insulin children release into their blood, the research team is working on defining which type of diabetes these children have.  

The Exeter team reached their conclusions by analyzing two bioresources: the Exeter pancreatic biobank, which contains more than 130 samples. This biobank is comprised of many cases of children who died soon after a T2DM diagnosis and is the most extensive resource of its kind in the world. They also studied the differences observed in the pancreas and whether it mirrored the blood of older patients diagnosed with T1DM. 

The Associate Professor at the University of Exeter Medical School, Sarah Richardson, said: “Our research could have a significant impact on current emerging therapies for type 1 diabetes. We see a lot of promise in immunotherapies which can slow disease progression, but so far, that hasn’t translated into effective new treatments. It could be that we need to focus on the use of different therapies in each age group, for these to be effective.” 

Dr. Elizabeth Robertson, the Director of Research at Diabetes UK, offered a very encouraging thought:  “The era of being able to halt the immune attack behind type 1 diabetes is in reach, but to make new treatments as effective as possible we need to get to grips with the complexity of the condition. Today’s news brings us one step closer to achieving that. 

“Being able to make the distinction between different subtypes of type 1 diabetes is an exciting new development, and we’re proud to have supported this landmark research. 

“We now need to make sure this discovery is used to design trials and tailor future treatments, so we can move closer to stopping and preventing type 1 diabetes.” 

The chief executive of JDRF, Karen Addington, said that “To prevent, treat and cure type 1 diabetes, we need to understand how this complex and challenging condition differs in childhood, adolescence and adulthood. These exciting study results provide a new perspective on type 1 diabetes across different age groups. We congratulate the research team on their progress. JDRF looks forward to further research in this area, exploring and applying these findings.” 

This research into T1DM can yield dramatic changes in how healthcare practitioners can diagnose and treat T1DM.  

The prospect of being able to prevent the immune reaction that destroys the functioning insulin–producing beta cells of the pancreas could prevent diabetes from ever occurring and give patients a much-improved quality of life wherein they no longer need to monitor themselves or need lifelong medication.  

The name of the study is ‘Studies of insulin and proinsulin in pancreas and serum support the existence of aetiopathological endotypes of type 1 diabetes associated with age at diagnosis.’ 

Practice Pearls: 

• Study finds that type 1 diabetes is distinguished as two separate endotypes, T1DE1 and T1DE2
• Patients with diabetes diagnosed below the age of 7 have one type and those patients diagnosed over the age of 13 have another type 
• The research is promising and could yield more insights into how to prevent the immune destruction of insulin–producing cells in the future 

Rigby, Sara. “Type 1 Diabetes Is ‘Two Separate Conditions’ Depending on Age at Diagnosis.” BBC Science Focus Magazine, Diabetologia, 16 Mar. 2020, www.sciencefocus.com/news/type-1-diabetes-is-two-separate-conditions-depending-on-age-at-diagnosis/. 

Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy 

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