There are a number of genes linked to type 1 diabetes (T1D), but not everyone with genetic predisposition develops the condition. This suggests that there are likely environmental triggers that stimulate the development of T1D. The Environmental Determinants of Diabetes in the Young (TEDDY), a study part supported by JDRF, is a large prospective, longitudinal cohort study investigating the environmental factors that may contribute to T1D development.
An article published by the TEDDY study group in Paediatric Diabetes this month highlights the benefits of early diagnosis of children at risk of T1D. Children involved in TEDDY are from six large clinical centres across the US and Europe and are being followed from birth until 15 years of age to track diet, illness, body growth and other life experiences.
Other longitudinal environmental studies such as DAISY, BABYDIAB and DiPiS have shown that children diagnosed due to regular monitoring have reduced rates of diabetic ketoacidosis (DKA) at diagnosis. It has not previously been shown if there are any longer term benefits to early diagnosis. The goal of this study was to explore whether a small cohort of young children diagnosed with T1D through the TEDDY study had higher C-peptide levels and less insulin needs during the first year after diagnosis compared with control children diagnosed through the community. This was the first large, prospective, age-matched effort to comparatively analyse preservation of C-peptide.
The results showed that 58% of TEDDY children had no symptoms such as weight loss or increased thirst at diagnosis, and none had diabetic ketoacidosis. Comparatively, 98% of the community controls diagnosed had diabetes symptoms and 14% experienced diabetic ketoacidosis. At diagnosis, average HbA1c was lower in the TEDDY children (6.8%, 51 mmol/mol) than later diagnosed children (10.5%, 91 mmol/mol).
TEDDY children produced significantly more C-peptide, and therefore insulin, than the other group throughout the first year after diagnosis. Total insulin dose and HbA1c were lower throughout the first-year post diagnosis for TEDDY children compared with other children.
These results are extremely important as this is the first study to show that there are longer term benefits to diagnosing T1D early. Children who were involved in the TEDDY project were less likely to have DKA at diagnosis and have the chance to participate in trials which could prolong their own production of insulin for longer – an idea which may delay or help prevent type 1 complications with better control for a longer period of time.
In Australia, the Environmental Determinants of Islet Autoimmunity (ENDIA) study is investigating factors in the environment that may be causative or preventative of T1D. The ENDIA study is following babies from pregnancy into the early childhood years with regular monitoring – every 3 months until 2 years and every 6 months thereafter. The results from the TEDDY study highlight potential benefits of close monitoring of people at risk of T1D. ENDIA is currently recruiting across all mainland states and regional areas – If you’d like to find out more about ENDIA, head to their website.
TrialNet is an international network of people dedicated to the prevention of type 1 diabetes. People at risk of T1D may be eligible for screening or prevention studies. Head to their website to find out more.