Dr Faye Riley, Senior Research Communications Officer at Diabetes UK, charts a changing landscape for type 1 diabetes
Type 1 diabetes is a serious and lifelong health condition, which currently affects more than 300,000 people in the UK. It happens when the immune system mistakenly attacks and destroys the cells of the pancreas that make insulin. This means people with type 1 diabetes can’t produce the insulin they need to survive so need to replace it through injections or a pump to stop blood glucose levels from becoming fatally high.
Type 1 diabetes requires round-the-clock careful self-management. It is vital that people are supported to manage the condition, because, without careful management, type 1 diabetes can lead to serious complications. In the short term, this includes diabetic ketoacidosis (DKA) – a life-threatening condition that requires urgent hospital treatment – as well as hypos (low blood glucose levels) which must be treated immediately by consuming fast-acting carbohydrates. Long-term complications of diabetes can be devastating and can include cardiovascular disease, kidney problems, as well as problems with vision. However, with the right treatment, knowledge and support, people living with type 1 diabetes can lead a long and healthy life.
Type 1 diabetes can be diagnosed in adults as well as children, and the four most common symptoms are the 4Ts – going to the toilet more than usual, being more tired and/or thirsty than usual, and unexplained weight loss (thinner). Type 1 diabetes is often not diagnosed until these symptoms become serious, requiring hospital treatment.
Challenges of managing type 1
A diagnosis of type 1 diabetes can be very overwhelming, and learning to live with the condition can be exhausting. For the last 100 years, people living with type 1 diabetes have used insulin to treat the condition. People with type 1 diabetes need to regularly monitor their blood glucose levels and work out the exact amount of insulin they need to take, several times every day, depending on what they eat, what they’re doing and how they’re feeling.
Maintaining this balancing act is relentless, and only around 30% of people with type 1 diabetes get the sort of ideal blood glucose control that will reduce their risk of long-term diabetes complications. (1)
Future of type 1 diabetes treatment
With a combination of insulin, blood glucose monitoring and carb counting being the most common way to manage type 1 diabetes, there’s an urgent need for new treatments that allow people a break from the continuous monitoring that the condition requires.
There’s no known cure for type 1 diabetes right now, and we still don’t fully know what causes the immune attack on the insulin-producing cells in the pancreas that is behind the condition. Researchers are working to understand this better and develop new treatments to target the immune system and deal with the root cause of type 1.
One of the most promising advances in recent years are immunotherapies. Immunotherapies could in future help to prevent, stop and cure type 1 diabetes by reprogramming the immune system so it no longer attacks insulin-producing cells in the pancreas. A landmark trial has shown that an immunotherapy called teplizumab could delay the diagnosis of type 1 diabetes by an average of three years in people who don’t yet have the condition but who are at high risk of developing it in the future. Teplizumab was recently assessed by the U.S. Food and Drug Administration (FDA) which decided that more data on how the body processes the drug was needed before it can be approved for treating those at high risk of developing type 1 diabetes. Provention Bio, the company that makes teplizumab, expect to have this evidence in place later this year.
Since the FDA’s initial review, teplizumab has now been submitted to the UK’s Medicines and Healthcare products Regulatory Agency (MHRA), which has awarded the drug an ‘Innovation Passport’ under the ‘Innovative Licensing and Access Pathway’. This pathway is designed to help speed up access to promising new medicines in the UK, paving the way for teplizumab to reach people at risk of type 1 diabetes in the UK too.
If approved, teplizumab could be the world’s first-ever licensed immunotherapy to treat type 1 diabetes, opening the door for more investment into immunotherapy research, and shifting the way we think about treating the condition.
Every day research takes us closer to being able to tackle the root cause of type 1 diabetes, but for people living with type 1 diabetes, every hour that passes brings with it more decisions, more balancing acts and more frustration. For people with or at risk of type 1 diabetes, immunotherapies have the potential to be life-changing, offering a better chance of a healthier future.
For more information about diabetes, visit diabetes.org.uk
(1) NHS Digital, 2019. National Diabetes Audit Report 1: Care Processes and Treatment Targets 2018-19.
