As we kicked off week 2 of our professional conference (DUKPC), scientists brought us trailblazing updates in progress to prevent type 1 diabetes. We also heard about research that’s putting the views of women with gestational diabetes at its heart and new insights into how the coronavirus pandemic is impacting care for the condition.
Preventing the type 1 immune attack
Prof Kevan Herold, from Yale University, has led on landmark research – showing for the first time that immunotherapy can slow the immune attack that causes type 1 diabetes, delaying the point at which someone is diagnosed with the condition. At DUKPC, he gave us a rundown of the latest results from this trial and how we’re moving us closer to a future where we could prevent type 1 diabetes entirely.
TrialNet, an international network of scientists dedicated to preventing type 1 diabetes, previously discovered that the immune attack behind type 1 diabetes has different stages. The first changes to the immune system can appear years, or even decades, before you’re diagnosed with type 1. Scientists can detect these changes in the blood to spot people who have a high risk of developing type 1 diabetes in the future.
This gives us a window of opportunity to disrupt the immune attack before it progresses too far in order to prevent, or at least delay, type 1 diabetes.
Prof Herold’s trial began in 2011 and involved 76 people, aged 8-49 years, who didn’t yet have type 1 diabetes but were at high risk. Half of the volunteers received a daily dose of an immunotherapy drug called Teplizumab for 14 days, and the other half received a placebo.
The scientists followed the volunteers to see who did and who didn’t develop type 1 diabetes. Five years after the treatment, 78% of people in the placebo group had been diagnosed with type 1 diabetes, compared to only 50% of those who were treated with the drug. The average time for people in the placebo group to develop type 1 diabetes was two years, while five years in those taking Teplizumab was five years. That’s an extra three years free from type 1 diabetes. You can read more about these results.
Prof Herold said now we know it’s possible to delay type 1 diabetes it’s time to start thinking about screening everybody in childhood, so that we can find those who are at high risk of developing the condition and get them treated with an immunotherapy. We’re moving into a new era for type 1 diabetes. One where instead of managing blood sugars in type 1 diabetes, the aim is to prevent the condition in the first place.
Better ways to support women after gestational diabetes
Gestational diabetes can increase your risk of developing type 2 diabetes later in life. There are things you can do to reduce that risk, but making changes, like eating well and moving more, can be difficult, and even more so for new mums.
To be able to better tailor support, researchers presenting their findings at DUKPC asked women with gestational diabetes what matters most to them.
Our research fellow Dr Claire Meek, with a team of researchers at University of Cambridge, interviewed women who’d had gestational diabetes. The research team wanted to know their views on 20 different possible interventions, all designed to help those who’d previously had gestational diabetes reduce their risk of 2 diabetes risk.
The researchers heard that the women would appreciate more advice about eating healthily and exercising with a busy schedule. And that interventions that supported them to fit manageable lifestyle changes into their daily lives would be the most helpful. Women were also eager to be screened for type 2 diabetes and felt that simple changes, like flexibility in appointments and sending invitations for tests, could help to maximise the number of women who go to their screening appointments.
This important research gives us a window into what matters most to women who’ve had gestational diabetes. We now need to see these insights used to shape future care to ensure women receive the right support for them to help reduce their risk of type 2 diabetes.
Gestational diabetes care during the pandemic
Dr Jane Hirst and a research team at the University of Oxford have been investigating the impact of the coronavirus pandemic on the diagnosis of gestational diabetes and its care.
Dr Hirst explained that gestational diabetes is usually diagnosed with a glucose tolerance test (GTT), which women need to attend a hospital appointment to have. But during the coronavirus pandemic, in light of lockdown rules and a reduced capacity to run outpatients services, the tests doctors used to diagnose the condition changed. As recommended by the World Health Organisation, either a random blood sugar test or HbA1c was used instead.
They looked at 668 women with gestational diabetes who were cared for in one hospital in South East England before the pandemic, and compared them to 144 women who were pregnant during the pandemic.
Their findings showed that whilst the number of women diagnosed per month remained similar after coronavirus hit, women tended to be diagnosed later on in their pregnancy. They also found that the pandemic had an impact on births and outcomes for babies. During the pandemic babies were more likely to be large, delivered by emergency caesarean section, or experience shoulder injuries at birth.
This suggests that the coronavirus pandemic is having a negative effect on gestational diabetes care. The condition affects one in six pregnancies in the UK, but with early intervention and the right support women with gestational diabetes can go on to have a healthy pregnancy. As the pandemic continues, it’s vital for the health of both mothers and babies that measures are put in place to ensure that diabetes care during pregnancy continues to meet the highest standards.
