Type 1 Diabetes
Type 1 diabetes is a disease in which the insulin-producing beta cells of the pancreas are destroyed by the immune system. Without insulin, glucose (sugar) is not transported from the bloodstream into the body’s cells, where it is needed. Thus, people with type 1 diabetes need lifelong insulin administration to regulate their blood glucose levels and to prevent the complications of the disease—e.g. blindness, kidney disease, heart disease, nerve disease. NIDDK-supported research has led to critical knowledge that has improved the health and quality of life of people with the disease.
- Before the discovery of insulin in 1921, type 1 diabetes was a fatal disease—people did not live beyond a year or two of diagnosis. After insulin was discovered, many people lived into adulthood, but with markedly decreased life expectancy
- Animal-derived insulin was the only treatment available to people with type 1 diabetes until the early 1980s, when the first biosynthetic human insulin was marketed. Around the same time, insulin pumps - small devices that deliver insulin - were found to be an effective alternative to multiple daily injections of insulin.
- People with type 1 diabetes could only monitor their glucose levels with urine tests, which today we realize is a very inaccurate marker of daily blood glucose levels. Urine tests generally recognized higher blood glucose levels, but the tests did not accurately reflect dangerously low glucose levels and reflected past, not current, glucose levels. By the 1980s, blood glucose meters had been developed and were widely used, enabling people to self-monitor blood glucose levels with finger sticks.
- Despite advances, people still had limited choices for managing their disease. Additionally, it was not known whether intensively controlling blood glucose levels would lower the risk of the eye, nerve, kidney, and heart complications of diabetes.
- Scientists had discovered loss of beta cells to autoimmunity as the underlying cause of type 1 diabetes. However, they did not know enough to even consider ways to prevent the disease or to replace the destroyed beta cells.
Today and Tomorrow
Improving Longevity of People with Type 1 Diabetes
- Many individuals diagnosed with type 1 diabetes can accurately measure their glucose levels, provide insulin in a more physiologic manger, and expect a normal lifespan. However, death rates in people with the disease are still much higher than those in the general population, and health disparities exist.
- As new technologies to manage the disease and/or strategies for prevention or reversal of type 1 diabetes become a reality, it is expected that all people with or at risk for type 1 diabetes will have normal life expectancy and improved quality of life.
Benefits of Intensive Glucose Control
- A landmark NIDDK-supported clinical trial and follow-up study, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications, showed that early and intensive blood glucose control dramatically delays or prevents the eye, nerve, kidney, and heart complications of type 1 diabetes—making early and intensive blood glucose control the standard treatment worldwide. NIDDK-supported research has also contributed to many new FDA-approved technologies that are giving people new options for managing their disease with more precise, less burdensome methods. For example, there are continuous glucose monitors (CGM) that provide real-time data of blood glucose levels without the need for finger sticks, improved formulations of insulin and glucagon (a hormone that raises blood glucose levels when an individual has hypoglycemia, or dangerously low blood glucose levels), and hybrid artificial pancreas devices that pair a CGM with an insulin pump to sense blood glucose and adjust insulin dosage automatically. Even with these major advances, managing type 1 diabetes still places a large burden on patients and caregivers.
- New glucose management technologies and approaches—such as artificial pancreas systems that require minimal or no patient input, or methods to replace beta cells so people start producing their own insulin again—will enable people with type 1 diabetes to achieve recommended blood glucose levels with less burden, prevent long-term complications, avoid hypoglycemia, and improve health.
Preventing Type 1 Diabetes
- Scientists have learned a great deal about the genetic contributors and underlying biology of type 1 diabetes, leading to the development of accurate tests to predict disease risk. This knowledge has enabled the pursuit of clinical trials to try to prevent or slow the disease before clinical onset. For example, a trial conducted by NIDDK’s Type 1 Diabetes TrialNet was the first to show that, with early preventive treatment targeting the immune system, clinical type 1 diabetes can be delayed by 2 or more years among people who are at high risk. The delay in developing type 1 diabetes is incredibly important given that it would also delay the time a person develops significant complications of the disease.
- It is anticipated that scientists will identify new approaches to prevent or slow progression of type 1 diabetes. Emerging research, such as through NIDDK’s TEDDY study, will reveal environmental contributors to the disease, leading to the development of new preventive therapies.
Developing Strategies to Replace Lost Beta Cells
- NIDDK-supported research has led to new knowledge about the biology of beta cells, enabling the development of new methods for large-scale laboratory production of these cells. Researchers are also studying strategies to protect these new beta cells from the autoimmune attack once transplanted into people with the disease. The NIDDK’s Human Islet Research Network is studying approaches for regenerating beta cells and is developing innovative technologies for testing therapies, such as “islet chips” that replicate the structure and function of human islets in a laboratory setting.
- Continued research may one day enable scientists to generate sufficient quantities of beta cells, implant them into a person with type 1 diabetes, and protect the newly transplanted beta cells from the autoimmune attack. Alternatively, beta cells remaining in the pancreas of a person with type 1 diabetes are stimulated to replicate, or other types of pancreatic cells are prompted to convert to beta cells. Restoring beta cell function in a person with type 1 diabetes eliminates the need for insulin administration and prevents disease complications.