Children under the age of seven who are diagnosed with type 1 diabetes have a different type from those diagnosed at aged 13, researchers reported last night.
Research published in Diabetologia shows for the first time that children who were diagnosed with the condition when they were under seven years of age do not process insulin properly and the cells that make it are quickly destroyed. However, children aged 13 and over when diagnosed often continue to produce normal insulin.
The University of Exeter, UK, researchers behind the study say their findings reignite important questions about whether or not these "dormant" insulin-producing cells could be reinvigorated to work more effectively.
They suggest new names for the two endotypes: Type 1 Diabetes Endotype 1 (T1DE1) for younger children being diagnosed and Type 1 Diabetes Endotype 2 (T1DE2) for older children and say that those diagnosed between the ages of seven and 12 could fall into either group.
The research team is working on ways to define which type of diabetes children have by studying the small amounts of insulin released into their blood.
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: T1DE1 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."
Prof Morgan and his team analysed two bioresources, including the Exeter pancreatic biobank, which comprises more than 130 samples, many of which come from children and young people who died soon after being diagnosed with type 1 diabetes.
They also looked at whether the differences in the pancreas are mirrored in the blood of people diagnosed with type 1 diabetes at increasing ages.
Sarah Richardson, associate professor at the University of Exeter Medical School, said: "Our research could have a significant impact on current emerging therapies for type 1 diabetes. We’re seeing 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, Director of Research at Diabetes UK, said: "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 help design trials and tailor future treatments, so we can move closer to stopping and preventing type 1 diabetes."
Karen Addington, UK chief executive of the type 1 diabetes charity JDRF, which funded the study, added: "These exciting study results provide a new perspective on type 1 diabetes across different age groups."
Leete P, Oram RA, McDonald TJ et al. Studies of insulin and proinsulin in pancreas and serum support the existence of aetiopathological endotypes of type 1 diabetes associated with age at diagnosis. Diabetologia 16 March 2020.
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