In this series we take a look at some of the exciting diabetes research developments announced recently, and what the findings could mean for people living with or affected by diabetes. We bring to you highlights from the annual European Association for the Study of Diabetes (EASD) conference in September, where diabetes researchers from across the world presented their latest breakthroughs.
In this month's article:
- #Type 1 diabetes risk differs between the sexes
- #Exposure to type 1 diabetes in womb may shield babies from the condition
- #Using voice to screen people for type 2 diabetes
- #Managing weight with one tablet a day
Type 1 diabetes risk differs between the sexes
Research has shown that being male increases the risk of a person developing type 1 diabetes, but we don’t know why. It’s been suggested that this might be explained by differences in the immune system or metabolism between the sexes.
Results presented at EASD showed that the risk of developing type 1 diabetes decreases significantly in girls after age 10 years but remains the same in boys.
Screening for specific markers in the blood called autoantibodies shines light on a person’s future risk of developing type 1 diabetes. Type 1 diabetes autoantibodies can appear in the blood months and years before people begin to show any symptoms and receive a type 1 diagnosis.
People who have one type 1 diabetes autoantibody have a higher risk of developing type 1 in the future than someone who has no autoantibodies. Those who test positive for two or more have a near 100% chance of developing the condition in their lifetime.
Dr Richard Oram and his team at the University of Exeter looked at data from the TrialNet Pathway to Prevention screening study to determine the risk of type 1 diabetes in 235,765 relatives of people with the condition.
Their analysis showed that a greater proportion of males in the study had screened positive for type 1 autoantibodies in their blood than females (5.4% and 5.0% respectively) and that males were more likely to screen positive for multiple autoantibodies.
The risk of developing type 1 diabetes was 7% higher in males who presented with a single autoantibody than in females with a single autoantibody. The risk of progressing to type 1 diabetes within five years in people with a single type of autoantibody was also significantly higher in males than females (21% and 14% respectively).
While the study found that the risk of developing type 1 diabetes was similar for males and females in childhood, it concluded that the risk dramatically decreased in females, but was sustained in males, after 10 years old.
The study authors said:
“Risk is similar between males and females in childhood, then at age 10 risk in females dramatically decreases, whereas risk is sustained in males. This suggests sex appears to be linked with autoantibody development, indicating the importance of incorporating sex in the assessment of risk.”
Exposure to type 1 diabetes in womb may shield babies from the condition
We know that if a family member has type 1 diabetes, there’s a slightly increased risk that another family member could develop the condition too. For example, the risk presented to a child if a parent has type 1 diabetes is between 1 and 9%.
Studies also show that the risk of developing type 1 diabetes is higher if a person’s father is affected rather than their mother, which suggests that there may be biological processes at play that shield the children of mothers with type 1 from the condition. Little is known about how this happens - and if this protection extends beyond early life.
Findings shared at EASD revealed that a child is nearly twice as likely to develop type 1 diabetes if their father has the condition than if their mother does.
Dr Lowri Allen at Cardiff University led the largest study of its kind to find out more. The group examined data collected from five studies on 11,475 individuals with type 1 diabetes (aged between 0-88 years at diagnosis).
Participants were almost twice as likely to have a father with type 1 diabetes as a mother with type 1, regardless of whether they were diagnosed as children or as adults, suggesting that the protection provided by a mother with type 1 may be carried into adult life.
Dr Allen said:
“Understanding why having a mother compared with a father with type 1 diabetes offers a relative protection against type 1 diabetes could help us develop new ways to prevent type 1 diabetes, such as treatments that mimic some of the protective elements from mothers...to prevent the onset of type 1 diabetes in individuals at high risk.”
The researchers added up the effects of over 60 genes known to be linked to type 1 diabetes to produce a ‘genetic risk score’. This was used to compare the inherited genetic risk of type 1 diabetes in people with affected parents.
The scores were similar between individuals who had either a mother or father with type 1 diabetes, indicating that the protection a mother gives a child against type 1 (compared to a father with type 1) isn’t due to the genes the child inherited.
Importantly, the study showed that the mother must have lived with type 1 diabetes during her pregnancy to confer a protective effect to her child. The researchers concluded that exposure to type 1 diabetes in the womb is likely key to this protection, but further research is needed to understand exactly why.
Using voice to screen people for type 2 diabetes
A previous study revealed that about 30% of people with type 2 diabetes in England, or around one million adults, are undiagnosed. This could mean that these people cannot access the help and support they need in time to maintain their health and reduce the risk of complications.
Currently, the only way to find out if someone has diabetes is through blood tests. These tests are invasive, time-consuming and costly. So researchers in Luxembourg set out to develop and test the performance of a voice-based AI tool to detect type 2 diabetes in adults.
The team asked 607 adults, diagnosed with and without type 2, to record themselves reading a few sentences of text. They then analysed these recordings to detect thousands of subtle changes in people’s pitch or tone that help to distinguish those with or without type 2 diabetes. They combined this information with people’s basic health data including age, sex, Body Mass Index (BMI), and blood pressure in an AI tool.
They found the AI tool showed a promising 71% accuracy in men and 66% in women at identifying people with type 2 diabetes. It was even better at detecting women with type 2 diabetes aged 60 or older, and people with high blood pressure.
Dr Abir Elbeji from the Luxembourg Institute of Health said:
“Combining AI with voice technology has the potential to make testing more accessible by removing these obstacles. This study is the first step towards using voice analysis as a first-line, highly scalable type 2 diabetes screening strategy.”
More research and tests are necessary before this voice-based method could be used to screen for type 2 diabetes. And the team are also working to improve the tools' accuracy and explore if it could detect early-stage type 2 diabetes and pre-diabetes.
Dr Lucy Chambers, Head of Research Communications at Diabetes UK, commented:
“Getting a prompt and accurate diagnosis is crucial for preventing the serious and life-limiting complications of type 2 diabetes. Unfortunately, symptoms can be easily overlooked, and about 1.2 million people in the UK are currently living with undiagnosed type 2 diabetes.
"Using AI to develop convenient and cost-effective type 2 diabetes screening methods will help identify more people who need treatment and support, ultimately improving their quality of life and reducing their risk of long-term diabetes complications. We look forward to further research on innovative AI voice analysis tools for diabetes screening.
"In the meantime, Diabetes UK’s ‘Know Your Risk’ tool can help you assess your risk of type 2 diabetes, and your healthcare team remains your most trusted voice for a formal diagnosis.”
Managing weight with one tablet a day
The first trial of a new once-a-day tablet has found it may help people living with overweight or obesity lose up to 13% of their body weight in three months.
The drug, called amycretin, works by mimicking and boosting two hormones that are involved in controlling our appetite and making us feel full.
The first, amylin, is a hormone in the body that can slow down how quickly food empties from the stomach and ‘tells’ the brain to reduce appetite. It also helps control how much sugar flows into the blood.
The second, called incretin, helps the body to produce more insulin when needed and lowers blood sugar levels.
While weight loss medications like GLP-1 agonists are already supporting some people with type 2 diabetes to lose weight, they are typically only available as injections. Therefore a treatment in tablet form could be more convenient and has the potential to benefit more people living with obesity or overweight.
The first in-human study of amycretin tested the tablet in people without diabetes with a BMI between 25 and 39.9. Those who took a low dose of amycretin for three months lost, on average, 10.4% of their body weight. This number increased to 13.1% in people who took a higher dose. In comparison, the average weight loss for people taking a dummy placebo tablet was 1.1%.
The drug appeared to be generally safe, although some people had side effects like nausea and vomiting. The next steps are to take amycretin to larger and longer trials to confirm if it’s safe and effective long-term.
Katie Bareford, Senior Clinical Advisor at Diabetes UK, said:
“Supporting people to lose weight is key to preventing type 2 diabetes and putting type 2 diabetes into remission. Developing oral versions of weight loss medications will extend the treatment options available for some people living with obesity or overweight who could be at risk of developing type 2 diabetes or those who already have the condition.
“It’s our view that people should be supported to find an approach to weight management that is most appropriate for them – whether that involves medication, changes to diet or bariatric surgery with the wraparound support of healthcare professionals.”
