There are a number of genes linked to type 1 diabetes (T1D), but not everyone with these genes will develop the condition. This suggests that there are likely environmental triggers that stimulate the development of T1D. The Environmental Determinants of Diabetes in the Young (TEDDY), a study part-supported by JDRF, investigates the environmental factors that may contribute to T1D development. An article published by the TEDDY study group in Paediatric Diabetes highlights the benefits of early diagnosis of children at risk of T1D. Children involved in TEDDY are from six large clinical centres across the US and Europe and are being followed from birth until 15 years of age to track diet, illness, body growth and other life experiences.
Other similar environmental studies worldwide have shown that children diagnosed due to regular monitoring have reduced rates of diabetic ketoacidosis (DKA) at diagnosis. DKA is a dangerous life-threatening condition that develops with prolonged high blood glucose levels.
The goal of this study was to explore whether a small cohort of young children diagnosed with T1D through the TEDDY study had higher C-peptide levels (a marker of insulin production) and less insulin needs during the first year after diagnosis compared with a control group of children diagnosed through regular channels.
The results showed that 58% of TEDDY children had no symptoms such as weight loss or increased thirst at diagnosis, and none had DKA. Comparatively, 98% of the control group had diabetes symptoms and 14% experienced diabetic ketoacidosis. At diagnosis, average HbA1c (a marker of long-term glucose control) was lower in the TEDDY children (6.8%) than the later-diagnosed children (10.5%).
TEDDY children produced significantly more C-peptide, and therefore insulin, than the other group throughout the first year after diagnosis. Total insulin dose and HbA1c were lower throughout the first-year post diagnosis for TEDDY children compared with other children.
These results are extremely important, as this is the first study to show that there are benefits to diagnosing T1D early. Children who were involved in the TEDDY project were less likely to have DKA at diagnosis and have the chance to participate in trials which could prolong their own production of insulin for longer – an idea which may delay or help prevent type 1 complications with better control for a longer period of time. The results from the TEDDY study highlight potential benefits of close monitoring for people at risk of T1D.
Prevention studies closer to home
In Australia, the Environmental Determinants of Islet Autoimmunity (ENDIA) study is investigating factors in the environment that may be causative or preventative of T1D. The ENDIA study is following babies from pregnancy through to three years of age with regular monitoring – every three months up until two years, and then six months until three years. ENDIA is currently recruiting in all mainland states and regional areas. If you’d like to find out more about ENDIA, head to their website.
TrialNet is an international network of people and institutions dedicated to prevention of type 1 diabetes. People at risk of T1D may be eligible for screening or prevention studies. Sign up on their website to find out more.