Highlights include: "Artificial pancreas" improves glucose control; T1DM often misdiagnosed as T2DM; and a genetic connection for “type 1.5 diabetes.”
Type 1 diabetes mellitus (T1DM) is characterized by the rapid and severe loss of insulin production by the pancreas; the insulin-producing beta cells in the pancreas are attacked and destroyed by the body’s immune system. Three new studies in T1DM and related disorders include: Delivery of hybrid closed-loop insulin improves glucose control and reduces the risk of hypoglycemia in patients with suboptimally controlled T1DM; T1DM is often misdiagnosed in older patients; and genomic analysis identifies genetic connection for “type 1.5 diabetes.”
Insulin Delivery System Improved Glucose Control in T1DM. Authors of the study assessed the effectiveness of a day-and-night hybrid closed-loop insulin delivery system, an artificial pancreas, vs a sensor-augmented pump therapy in people with suboptimally controlled T1DM. Authors recruited 86 patients aged ≥6 years from diabetes outpatient clinics, 4 in the UK and 2 in the US, who were randomized to either a closed-loop group or a sensor-augmented pump group.
Author's Insights. Study found that the use of the artificial pancreas improved glycemic control while reducing the risk of hypoglycemia in patients. Reductions in A1c was significantly greater in the closed-loop group vs control group and the proportion of time that glucose concentration was within target range, was significantly higher in the closed-loop group vs control.
For more information: Tauschmann M, Thabit H, Bally L, et al. Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet. 2018;392:1321-1329.
T1DM Misdiagnosed as T2DM in Adults. The population cohort study aimed to determine the prevalence and characteristics of T1DM that leads to severe insulin deficiency. Study included 583 patients who had insulin-treated diabetes and had been diagnosed after the age of 30. The characteristics of their disease were compared with other participants who still produced some insulin, as well as with 220 individuals with severe insulin deficiency who were diagnosed before the age of 30.
Author's Insights. The results showed 21% of those with insulin-treated diabetes had severe insulin deficiency. Some 39% of these patients did not receive insulin when they were initially diagnosed; nearly half (46%) of them self-reported that they had T2DM. A rapid progression to insulin dependence was highly predictive of late-onset T1DM, with 94% of T1DM patients requiring insulin within 1 year. Among participants who became insulin-dependent within 3 years, 44% developed a severe innate insulin deficiency. Those patients who had insulin treatment delayed were much more likely to have been given oral hypoglycemic drugs in an attempt to control their disease.
For more information: Thomas N, Grubb A, McDonald T, et al. Type 1 diabetes leading to severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes in clinical practice. Paper presented at: 54th Annual Meeting of the European Association for the Study of Diabetes; October 2018; Berlin, Germany.
Genomic Study of "Type 1.5 Diabetes." Latent autoimmune diabetes in adults (LADA), or "type 1.5 diabetes," shares clinical features with T1DM and T2DM, however, there is an ongoing debate regarding the precise definition of LADA. Authors of this study, the first genome-wide association study of LADA in cohorts of European ancestry, analyzed 2634 LADA cases vs 5947 control subjects. Secondary analyses compared 2454 LADA cases vs 968 T1DM cases and 2779 LADA cases vs 10 396 T2DM cases.
Author's Insights. Study found that the strongest genetic signals in LADA are mainly shared with established variants known to be linked to T1DM. However, a novel locus with genome-wide significance was discovered near the gene PFKFB3, which codes for a protein that regulates both insulin signaling and glycolysis.
For more information: Cousminer DL, Ahlqvist E, Mishra R, et al. First genome-wide association study of latent autoimmune diabetes in adults reveals novel insights linking immune and metabolic diabetes. Diabetes Care. 2018;41:2396-2403.