Stopping Type 1 Diabetes Before It Starts
Each year, World Diabetes Day is celebrated on November 14, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. For nearly a century, insulin has been helping people with type 1 diabetes (T1D) – once a uniformly lethal disease – live relatively normal lives. But they still face life-threatening symptoms, disease related morbidities and constant worry. What if we could stop the disease before it starts, dispelling the need for insulin altogether? What if we no longer had to recognize T1D in the context of World Diabetes Day? These are the questions World Without Disease Accelerator (WWDA) scientists at Janssen are focused on addressing today and every day.
2019: A reality check and a turning point in innovation
As we look at the history of research in type 1 diabetes (T1D), we face a jarring truth: over the past 100 years, there has been very little refined innovation in the treatment or management for this disease, especially when compared with advances seen in other autoimmune diseases in the last 50 years. Even more concerning is that in recent decades, the incidence of T1D has risen steadily around the world. 1
Individuals with T1D suffer from dangerously poor glucose control and sadly, often a reduced lifespan, and that’s despite advancements in technology. Younger patients, particularly those in their teens, frequently struggle to control their T1D, and those diagnosed in early childhood face even shorter life expectancies than people who aren’t diagnosed until adulthood. Prevalence of diabetic ketoacidosis (DKA) – a major complication that causes dangerous levels of acid in the blood – is also rising, possibly due to delayed disease detection, warranting a need for more vigilant T1D symptom screening.
Fortunately, in recent years, the research community’s overall understanding of T1D biology has dramatically improved thanks to cohort studies and biomarker science, and an incredibly passionate patient advocacy community. World Diabetes Day 2019, while a reminder of a growing unmet need facing a diabetes population, also signals an opportunity for change and focused innovation. And the WWDA team hopes to contribute in shifting the industry’s perspective and approach to T1D.
A world without diabetes is within reach
We have come to understand that a multi-year window exists between the time of a T1D diagnosis and when symptoms begin to emerge, which fuels the mission and passion of our work. Our priority is to stop disease before it starts, utilizing the rapidly emerging science of immune diagnostics and precision medicine to create solutions that aim to transform the health care paradigm, but more importantly patients’ lives.
We have found success in exploring the concept of disease interception and delaying the onset of T1D, instilling confidence and belief in our mission. For instance, during the American Diabetes Association (ADA) 2019 Scientific Sessions this year, promising results were presented by Provention Bio, Inc. about the potential of an investigational drug to delay the onset of T1D in children and adults at high risk for T1D. Further, the life sciences industry recognizes that the burden of rising T1D incidence is not something to be deferred. Globally, scientists are advancing new mechanisms, antibodies, biomarkers and genetic and environmental influences associated with T1D pathogenesis, strengthening the potential to combat this debilitating disease. In fact, many institutions are beginning to prioritize early detection and improved outcomes for at-risk patients of T1D.
Writing a new chapter for diabetes: It’s personal
When I was six years old, I was diagnosed with juvenile idiopathic arthritis (JIA), which is, like T1D, an autoimmune disease. However, in the decades since my diagnosis, JIA treatment and the inhibition of its destructive nature have advanced – contrary to that of T1D. This inconsistency is what pushes me to accelerate change for people on a path to T1D.
In the near term, increased awareness of T1D and its warning signs may help to reduce DKA incidence through increased screening. In the long term, with awareness of the growing unmet need in T1D, comes the opportunity to intercept the disease. If we envision a world where patients have multiple options to delay the onset of the disease, and where we eventually induce a remission or indefinite delay in T1D progression – maybe we can make it a reality.
I’ve been managing my autoimmune disease for many, many years. To this day, my father still calls to check on me, concerned about how I’m doing. T1D, like JIA, is a chronic condition – patients and families can’t take a break from it, so neither will we.
 Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013:a multicentre prospective registration study. Diabetologia (2018). https://doi.org/10.1007/s00125-018-4763-3