Can type 1 diabetes be delayed or prevented?

Researchers are making important strides in figuring out how type 1 diabetes (T1D) develops and discovering ways that might help slow down its onset—especially in children and teens who are at higher risk. Although a cure or complete prevention remains out of reach, new therapies and advances in screening are offering families hope. Here’s the latest on what science has uncovered and what it could mean for families in Canada and beyond.

How does type 1 diabetes develop?

Type 1 diabetes tends to develop when the body starts to make antibodies (proteins made by the immune system to fight infections), that mistakenly target beta cells, which are responsible for producing insulin. This destruction is gradual; by the time symptoms appear, around 80% to 90% of insulin-producing cells may already be gone. Genetic factors, family history and possibly triggers in the environment (such as viruses) all play a role in this autoimmune process, though many questions remain.

How can we determine who is at higher risk for developing T1D?

Researchers have identified certain genetic markers and antibodies that signal a higher risk for developing type 1 diabetes. People with a first-degree relative (i.e., parent, child or sibling) or a second-degree relative (aunt/uncle, grandparent, cousin) with type 1 diabetes, as well as those with a personal or family history of other autoimmune diseases, have a significantly increased risk, however, screening for specific autoantibodies in the blood offers the most accurate prediction.

Where can we find out about T1D screening or further research studies?

Some hospitals and clinics may have access to autoantibody screening.

The following organizations and studies provide information and access to screening:

• Several organizations and studies provide information and access to screening:
  • TrialNet: An international research network that offers free risk screening (the “Pathway to Prevention” study) for relatives of people with type 1 diabetes, often identifying risk years before symptoms appear.
  • CanScreen T1D: A Canadian research consortium studying how acceptable and feasible a national pediatric screening program for type 1 diabetes would be, developed in collaboration with people living with diabetes, families, and healthcare providers.
  • uncovert1d.ca: Offers information and resources from Sanofi and connects families to screening opportunities.

Families may also learn about research studies through organizations such as Diabetes Canada, Breakthrough T1D (formally JDRF) and local research hospitals.  These screening programs often test for protective or at-risk genetic markers and autoantibodies, providing individuals with information about their own or their child’s risk level and potential access to research studies.

Can type 1 diabetes actually be prevented?

Right now, there is no way to fully prevent type 1 diabetes. Unlike type 2 diabetes, which can often be delayed or prevented with lifestyle changes, type 1 is an autoimmune condition. The body’s immune system attacks its own beta cells and this process usually cannot be stopped once it begins. However, researchers are encouraged by immunotherapy trials, which suggest it may be possible to delay the onset of T1D in people at high risk.

Are there treatments to delay T1D available in Canada?

Promising results have emerged in recent years.  Research groups such as TrialNet are studying various therapies to delay the onset of T1D, one of which was teplizumab (an immunotherapy medication). This medication has been shown to delay the diagnosis of type 1 diabetes by approximately two years in people eight years of age and older. It works by temporarily calming the immune system’s attack on insulin-producing cells. Health Canada recently granted Notice of Compliance (market authorization) for teplizumab in those with 2 or more antibodies and early signs of changes in blood sugar, as research continues to assess the use of teplizumab in later stages of T1D. Delaying the need for daily insulin injections for a meaningful amount of time is a breakthrough in T1D prevention and care.

Are there other treatment options being studied?

Researchers are testing many different approaches. These include oral and injectable drugs that target the immune system, vaccines that aim to retrain immune cells not to attack the beta cells, and even dietary changes in infants to reduce risk. Trials are ongoing, with some therapies showing the ability to prolong insulin production or slow the progression from early-stage, asymptomatic diabetes to symptomatic diabetes.

Why the future looks brighter for T1D

Rapid advances in screening and the first successful therapy—such as teplizumab—that can delay the disease onset look very promising. Screening and monitoring early stage T1D can also reduce the likelihood that affected individuals will present with diabetic ketoacidosis, a life-threatening complication of high blood sugar. Early screening allows individuals to participate in studies or therapy trials, and new drugs could further delay or reduce symptoms. As the understanding of the immune system grows, researchers are confident that even more effective therapies will become available, bringing real hope for the next generation.