Type 1 diabetes found to be two distinct conditions depending on age

Children who are diagnosed with type 1 diabetes under the age of seven have a different form of the condition compared with those diagnosed aged 13 or above, new research has shown.

The new study, conducted at the University of Exeter, has shown for the first time that children who were diagnosed under seven years old do not process insulin properly and the cells that make it are quickly destroyed.

Surprisingly, those who are older at diagnosis (aged 13 or over) often continue to produce normal insulin; findings which reignite important questions about whether these “dormant” insulin-producing cells could be reinvigorated to work more effectively.

In its paper, the Exeter team has suggested new names for the two distinct endotypes: Type 1 Diabetes Endotype 1 (T1DE1) for that diagnosed in the youngest children, and Type 1 Diabetes Endotype 2 (T1DE2) for those who are older at diagnosis.

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.”

The paper proposes that children diagnosed between the ages of seven and 12 could fall into either the T1DE 1 or T1DE2 group. The research team is now working on more precise ways to define which type of diabetes such children have by studying the small amounts of insulin released into their blood.

The Exeter team reached their conclusions by analysing two bio-resources including the unique Exeter pancreatic biobank comprising more than 130 samples, many of which come from children and young people who died soon after being diagnosed with type 1 diabetes. This is the most extensive resource of its type anywhere in the world. They also studied whether the differences seen 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.”

The study has been published in the Diabetologia. The research was funded by Diabetes UK and JDRF.