The American Diabetes Association’s 83rd Scientific Sessions is here! Scientists will present the latest type 1 diabetes (T1D) research, from beta cell replacement to regeneration, and glucose and complications trials, all with the goal of improving lives for the T1D community.
Here are Breakthrough T1D-funded researchers Drs. Sarit Polsky, Riitta Veijola, Maria Golson, and Patrice Fort to share their key takeaways from day 3, with their commentary in the video and below:
Sarit Polsky, M.D., MPH
Director, Pregnancy and Women’s Health Clinic, Barbara Davis Center for Diabetes, University of Colorado
Area: Automated Insulin Delivery Use among Pregnant Women with Type 1 Diabetes—Past, Present, and Future
Managing T1D with pregnancy is difficult, and artificial pancreas, or automated insulin delivery (AID), systems—for the most part—are not tailored to pregnancy. There are significant changes to insulin requirements over the course of pregnancy, making it difficult for pregnant women to achieve blood-sugar targets. Continuous glucose monitors (CGMs) help women increase their time spent in the optimal, pregnancy-specific time-in-range, but even with CGM some pregnant individuals do not reach their targets until the last few weeks of pregnancy.
Presenting on AID systems in pregnancy were Helen Murphy, M.D., FRACP, Carol Levy, M.D., CDCES, Sarit Polsky, M.D., MPH, and Denise Feig, M.D., M.Sc., FRCPC. They discussed the commercially available system for pregnancy (CAM APS, the only available system for pregnant women), “off-label” AID systems (like Medtronic, Tandem, Insulet, and iLet—which are not approved for pregnancy), and those in clinical trials, including one that has a special pregnancy-specific algorithm, developed by Harvard researcher (and Breakthrough T1D-funded) Eyal Dassau, Ph.D.
There are still a lot of things in the future we have to figure out—What is the optimal time-in-range? Should it be different overnight or during the day? What are the barriers to automation, such as cost and skin issues? There are currently five studies underway, with results that will be published in the next year or two.
“We’ve made a lot of progress and it’s all very exciting,” says Dr. Polsky, “so we all have a lot to look forward to.”
Riitta Veijola, M.D., Ph.D.
University of Oulu
Area: Joint ADA/Breakthrough T1D Symposium—Global Perspective on Population Level Type 1 Diabetes Screening and Monitoring
Anette-Gabriele Ziegler, M.D., Cristy Geno Rasmussen, MPH, Ph.D., and Riitta Veijola, M.D., Ph.D., presented on global screening in Europe and the United States, in a session run by Breakthrough T1D’s own Sanjoy Dutta, Ph.D., chief scientific officer at Breakthrough T1D. Dr. Veijola, who has been working on the development of T1D in children for almost 30 years, summarized the screening process. In Finland—the country with the highest rate of T1D—the most common age when islet autoantibodies appear is around 1 year, for reasons that are being explored in current studies.
2+ autoantibodies—antibodies that are directed toward your own body—means you have an almost 100 percent chance of developing T1D in your lifetime.
A screening test can tell you if you have 2+ autoantibodies. If you do, blood-sugar levels need to be monitored for the onset of type 1. You can do this in multiple ways. The traditional way is a glucometer with strips. A more modern way is continuous glucose monitoring (CGM) technology, which gives you your blood-sugar levels every 5 minutes. Another measure is to test HbA1c, which can tell you about blood-sugar levels over the past 12 weeks.
Monitoring can help you avoid diabetic ketoacidosis (DKA)—a complication of T1D when there is too much blood sugar, that can lead to death if not caught early. Monitoring also gives you time to learn about T1D and an opportunity to take part in preventive treatment, like Tzield™ (teplizumab-mzwv), or a clinical trial. To learn more about screening and monitoring, go to our T1Detect program.
Maria L. Golson, Ph.D.
Assistant Professor, Johns Hopkins School of Medicine
Area: The Islet-Cell Interactome
Alpha cells! Beta cells! Delta cells! Oh my! Maria Golson, Ph.D., and the presenters in her session, Manami Hara, DDS, Ph.D., Danielle Dean, Ph.D., and Abdelfattah El Ouaamari, Ph.D., talked about the other cells and blood vessel architecture in T1D, and how they contribute to beta cell failure.
Dr. Golson presented on delta cells, which produce somatostatin, a hormone that inhibits insulin secretion and is also released in response to high glucose as the hormone helps regulate the gastrointestinal tract. Next up was Dr. Hara, who talked about the blood vessel system in the islets, who demonstrated that there’s more interaction than previously thought between the blood vessel tissue and islet tissue. Dr. Dean spoke about glucagon, which is secreted by the alpha cell, which is also important for regulating insulin secretion. Finally, Dr. El Ouaamari found that islets have different sensory neurons, which might explain some of the differences in diabetes incidence in males and females.
Islets were previously thought to be made up of different cells, each responsible for a singular function. Now, we see that these different cells communicate with and among each other. Additional study of these interactions could help illuminate a path to new research and therapies that act upon these intercellular actions.
Patrice Fort, M.S., Ph.D.
Associate Professor and Director, Biorepository and Resource Center, University of Michigan
Area: Creating a World without Visual Loss from Diabetes
Patrice Fort, M.S., Ph.D., presented on the Mary Tyler Moore Vision Initiative (MTM Vision), with S. Robert Levine, M.D., the husband of the late Mary Tyler Moore and creator of MTM Vision, and Jennifer Sun, M.D., MPH. The first part of this initiative, due to a workshop hosted by Breakthrough T1D in 2018, is a new Diabetic Retinal Disease Staging System, to update the grading system that has not been changed for 50 years, despite the advancement of our understanding the disease and its presentation. An article outlining the new Diabetic Retinal Disease Staging System is set for publication in the coming months.
The workshop also detailed the state of the science, and outlined scientific needs and opportunities, which helped establish a “roadmap” for next steps.
One of these, presented by Dr. Fort, is collecting and characterizing different stages of the disease, to do a very in-depth analysis of those tissues to identify new potential targets to be developed with pharma companies or other academic centers. Another one, presented by Dr. Sun, is new clinical endpoints and biomarkers for better characterization of the progression of the disease. She is spearheading clinical trials that will take place at the beginning of next year.
MTM Vision’s goal is to lead to the development of therapies that will reduce or reverse vision-threatening diabetic eye disease development and progression. Ultimately, it aims to create a world without visual loss from diabetes, honoring Mary Tyler Moore’s commitment to diabetes awareness and research.
