Childhood diabetes

| An autoimmune disease |
As soon as the little guy heard the music, he began to swing his hands and feet. He likes everything that flickers, likes to eat soft sausages with a spoon at dinner, and is now learning to walk – all in all, just like all healthy one-year-olds. There is only one difference that casts a shadow over the future of Paul (a pseudonym) – the chance of a boy getting type 1 diabetes by the age of ten is about 7.5%, well above the 0.3% average.

Paul is not genetically inherited by the family, and his family does not have any type 1 diabetes. Paul participated in a screening study at the University Hospital in Dresden: shortly after his birth, doctors examined about 50 genetic loci in his genome that would affect the risk of type 1 diabetes.

The genetic locus examined is related to the immune system, because type 1 diabetes is an autoimmune disease: it may be caused by infection, and the defense system of the body begins to attack the beta cells that produce insulin in the pancreas until the body can no longer produce enough Insulin that regulates blood sugar levels. Therefore, patients with type 1 diabetes are required to inject insulin throughout their lives.

“If he really has diabetes, we can handle it,” Paul’s parents said. Since he was able to eat solid food, his rice paste has a white powdered drug every day. Because Paul is participating in another study, he received an immunotherapy, similar to desensitization for bee venom or pollen allergy, to delay the onset of diabetes for years, or even prevent it from developing.

The prevalence of children with type 1 diabetes increases by an average of 3-4 percentage points per year for unknown reasons. In Germany, approximately 3,000 children are diagnosed with this disease each year.

| Breaking the inevitability of the disease |
At the same time, the disease is no longer seen by the medical community as an unchangeable fate.

“In my more than 20 years of diabetes research, most doctors believe that the onset of type 1 diabetes is unavoidable,” said Kalum Sutherland, a professor of molecular medicine at the University of Dundee in Scotland. So people’s focus is on how to improve insulin therapy, and new research results have changed this long-standing pessimistic atmosphere. “At the same time,” Sutherland said, “the same number of researchers believe that type 1 diabetes can be avoided.”

In essence, there are four kinds of developments that give doctors, parents, and patients full confidence, and may break the inevitability of type 1 diabetes:

Children who are at risk of illness and are eligible for preventive treatment like Paul can now be confirmed through various screenings.

From the many failures of diabetes immunotherapy, the medical community has gained a lot of important insights, such as the right timing and dose of treatment, and most importantly, which immunotherapies are safe and can be used to treat children.

Although type 1 diabetes appears to be sudden, even with coma, it can be life-threatening or requires intensive care, but in fact the disease usually develops for many years. During this time, people can effectively observe the slow changes in the autoimmune response and wait for the right time for treatment.

A series of preventive immunotherapy methods are currently being tested in clinical trials, which will increase the chances that a certain method (or a combination of methods) will eventually take effect. Some methods apply to children at risk of illness like Paul, while others apply to children at the onset of the disease.

| Preventive immunotherapy for type 1 diabetes |
“We have made progress.” said Jay Skeller, a professor at the University of Miami Diabetes Institute, who is working on a cure for type 1 diabetes. He launched the first diabetes immunotherapy study in 1984. “At the time we didn’t make any progress, but we realized that this idea is correct.”

To date, Skyler has participated in 21 studies aimed at preventing or suppressing type 1 diabetes, but he did not want to answer the specific time when the preventive therapy was launched. “Research takes time, people have to wait patiently.” The 72-year-old Skyler is still “very optimistic”: “We will certainly overcome this disease, I hope I can have a chance to see that day.”

If we can successfully postpone the onset of puberty and retain more of the remaining functions of beta cells, we have already achieved great victories.

One of the treatments that brought hope to Skyler and his colleagues was the white powder that Paul had eaten in rice paste, a powdered insulin. In fact, the consumption of insulin does not affect blood sugar levels, the main purpose is to use the molecules to train Paul’s immune system. If successful, Paul’s immune system recognizes insulin as an endogenous, harmless substance. This principle works for high-risk children who are allergic to peanuts. Since 2017, the National Institute of Allergy and Infectious Diseases has recommended feeding peanuts with high risk of peanut allergy for 4-6 months. Food, this way can reduce its future allergy risk by 81%.

In the prevention of type 1 diabetes, the idea of ​​supplementing insulin is not new. There have been some studies on this, and no dangerous side effects have been found so far. It may still be ill at the end – some large studies have failed, and the researchers suspect that insulin is administered too late and the dose is too low. In Paul’s latest research project, insulin doses increased to nine times the original dose.

| Early detection of the meaning of risk children |
Researchers from Germany, Belgium, Sweden, Poland, and the United Kingdom conducted diabetes risk tests on about 300,000 infants and toddlers, and eventually found 1,040 children like Paul to participate in the study, and the results will be available in six years.

Even if it proves effective in the future, it may not help every patient, and the researchers don’t know if insulin powder can really stop the onset of diabetes. “However, if we can successfully postpone the onset of puberty and retain more of the remaining functions of beta cells, we have already achieved great success,” said the research director and the Institute of Diabetes, Helmholtz Center, Munich Changanette Gabriela Ziegler said, “Because of this, blood sugar levels can be better controlled.”