Scientists discover why type 1 diabetes is worse in children

Scientists have discovered why type 1 diabetes is more severe and aggressive when it develops in young children.

Type 1 is caused by the immune system attacking the cells in the pancreas that control blood sugar levels.

The research team showed that the pancreas was still developing in childhood, especially before the age of seven, making it much more vulnerable to damage.

They say newly developed drugs could give patients time for the pancreas to mature, delaying the disease.

Type 1 diabetes affects around 400,000 people in the UK.

Eight-year-old Gracie, originally from Merseyside, suddenly fell ill on Halloween 2018. It started as a mild cold but quickly worsened.

“She went from being a very happy one-year-old, who went to nursery, danced and sang, to almost dying in less than 48 hours,” says Father Gareth.

“Diagnosis is still the worst part of our lives. Suddenly, everything we took for granted became 10 to 20 times more difficult,” he says.

The Nye family had to adapt quickly: keeping tabs on everything Gracie had to eat or drink, monitoring blood sugar levels, and administering the hormone insulin to tell her body to absorb blood sugar.

Gracie now has a glucose monitor and an insulin pump and is “managing her diabetes,” her father says.

“Gracie is a superstar,” he adds.

But it remains a mystery why children diagnosed like Gracie, especially those younger than seven, have a more aggressive disease than those diagnosed in adolescence or later.

The study, published in the journal Science Advances, shows that it is due to the development of beta cells that live in the pancreas.

These are the cells that release the hormone insulin when blood sugar levels rise after eating.

Researchers at the University of Exeter studied pancreas samples from 250 donors, allowing them to see how beta cells normally formed as people aged and in type 1 diabetes.

Earlier in life, these beta cells were shown to exist as small groups or as single cells, but as we age they grow in number and mature into larger groups known as Islets of Langerhans.

The study was able to see what happened after the immune system turned against the patient’s own beta cells.

Beta cells in small groups were removed and destroyed so that they never had a chance to mature.

Those in the larger islets were still attacked, but they were longer lasting, allowing patients to continue producing low levels of insulin, which reduced the severity of their disease.

“I think this is a really significant finding for type 1 diabetes – this research really sheds light on why the disease is more aggressive in children,” Dr Sarah Richardson, from the University of Exeter, told the BBC.

He said “the future is much brighter” for children now diagnosed with type 1 diabetes.

This includes the possibility of screening healthy children for the disease and new immunotherapy drugs to delay it.

The UK has authorized teplizumab, an immunotherapy that can stop the immune system from attacking beta cells and can give them time to mature, although it is not available on the NHS.

“Because we have new medications for the treatment of type 1 diabetes in children, we hope they can prevent or delay the onset in these young people,” Dr. Richardson said.

The research was part of the Type 1 Diabetes Grand Challenge organized by the Steve Morgan Foundation, Diabetes UK and Breakthrough T1D.

Rachel Connor, director of research partnerships at Breakthrough T1D, said: “This study gives us a missing piece of the puzzle, explaining why type 1 diabetes progresses so much faster in children than in adults.”

Dr Elizabeth Robertson, director of research and clinical practice at Diabetes UK, said: “Uncovering why type 1 diabetes is so aggressive in young children opens the door to the development of new immunotherapies aimed at slowing or stopping the immune attack, potentially giving children the most valuable years without insulin therapy and, one day, avoiding the need for it altogether.”