JDRF Research
Global Diabetes Research Forum: Science, Hope for Adults with Type 1 Diabetes
Research findings and innovative approaches offer the promise of new therapies and the potential for cures for adults living with type 1 diabetes, according to researchers at JDRF’s 2008 Global Diabetes Research Forum, which took place this past June in Washington D.C.; the event, held each year at JDRF’s Annual Conference, highlighted promising scientific developments and important directions in type 1 research. The GDRF focused on adults with type 1 this year because fully half of those diagnosed each year with type 1 diabetes are adults.
As research has improved diabetes care over the years, and people with the disease live longer and with fewer complications, adults with diabetes may have lived with their disease for more than 90% of their lives. The forum also looked to focus attention on JDRF-funded science aimed at curing established type 1 diabetes, as JDRF’s success in the recent past with cure therapeutic advances in the newly diagnosed setting—such as anti-CD3 compounds—may have overshadowed the fact that a significant portion of JDRF’s funding goes towards reversing the disease in people who have been living with diabetes for years, if not decades.
Producing Insulin—Even 50 Years After Diagnosis
Among the research presented were insights from the Medalist Study, an ongoing project at the Joslin Diabetes Center in Boston, Massachusetts, whose main objective is to answer the question, “Can complications of diabetes be avoided or stopped?” The study recruits patients with long-duration type 1 diabetes, and has created a recognition program for people who have been insulin-dependent for 50 years or longer.
George King, M.D., Senior Vice President and Director of Research at the Joslin Center, and the study’s lead investigator, said that research shows that individuals with established type 1 diabetes (even those who have lived with it for 50 years or more) are still capable of producing insulin. The Joslin Study also found that even after 50 years, about 30% of the patients studied did not experience any of the common complications such as eye, kidney, or nerve disease. These findings show that complications can indeed be prevented, and point to the way towards the possibility of improved clinical outcomes for all type 1 diabetes patients.
Potential for Beta Cell Regeneration
Mark Atkinson, M.D., Director of The Diabetes Center of Excellence at the University of Florida, presented initial findings from nPOD—the Network for Pancreatic Organ Donors with Diabetes. Organized and funded by JDRF, the network was established last August to procure and characterize, in a collaborative manner, pancreatic and related tissues from organ donors with long-standing type 1 diabetes as well as those who are islet-autoantibody positive. These tissues are being used to study how type 1 diabetes develops, with the aim of finding a means to a cure.
Dr. Atkinson described findings from nPOD that have enabled researchers to assess the potential for islet cell regeneration.“Contrary to common dogma, what we’ve learned so far is that some pancreata from subjects with long-standing type 1 diabetes have insulin-positive beta cells and some have many intact islets.
This finding gives hope for islet cell regeneration or restoration,” Atkinson noted. He pointed out another key finding: that some islets have beta cells that don’t produce insulin. “If we know beta cells are there, then we can focus on finding ways to get them to produce insulin,” Dr. Atkinson explained.
Natural regenerative abilities in individuals without diabetes are also being explored. JDRF’s Chief Medical Officer, Paul Strumph, MD, presented findings that showed how beta cell mass expands in response to increased metabolic demands, such as growth during the first decade of life, obesity, and pregnancy.
Possible therapeutics may therefore be developed if scientists can mimic these or other biological mechanisms that increase the number of insulin-producing cells in the pancreas. “A little bit of insulin is not a cure, but it can be significant to reduce the complications of diabetes,” Dr. Strumph noted.
A New Era of Diabetes Research
All of the presenters agreed that researchers are on the cusp of a new era in diabetes research, one in which advanced technology and human clinical research should enhance the development of new therapeutics and an ultimate cure.
“Much of what we’ve known regarding the pathogenesis of type 1 diabetes has dated back to studies performed with the human pancreas in the 1970s—before microwaves, the internet and cell phones, and before modern day medical research technology. Now we’re looking at this disease in whole new ways,” Dr. Atkinson explained.
Dr. Strumph added that there is more of an emphasis now on looking at the natural history of the disease to guide research opportunities in those with established type 1 diabetes. JDRF devoted a significant portion of the $160 million in research it committed last year to science involving patients with established type 1 disease, with a particular emphasis in the areas of autoimmunity and regeneration; the organization plans to fund as much as $195 million on diabetes research in the coming 12 months.
