New Research Applies the Brakes to Type 1 Diabetes

A prevention study involving diabetes researchers and volunteers at Benaroya Research Institute at Virginia Mason (BRI) showed a drug that targets the immune system — Teplizumab — can delay type 1 diabetes up to three years in children and adults at high risk.

“This is great news for relatives of people with type 1 diabetes, who are at 15 times greater risk of the disease than the general population,” said Carla Greenbaum, MD, director of Interventional Immunology and the Diabetes Research Program at BRI.

Samples collected during the trial are being studied to help researchers understand why certain people responded to the drug better than others. Next, TrialNet researchers hope to conduct additional studies to look for ways to extend the benefits of the drug.

New Insight into Disease Progression
BRI Alice Long

BRI researcher Alice Long, PhD

When some people are diagnosed with type 1 diabetes, the disease progresses so quickly that their pancreas stops making insulin within a year. For others, the process is slower and their disease easier to manage. BRI research revealed that it’s possible to identify the “fast progressors” early and match them with treatments that help keep them healthy for longer.

BRI’s Alice Long, PhD, and her colleagues made the discovery that opened the door to potential new treatment strategies for type 1 diabetes. In a paper published in Journal of Clinical Investigation, the researchers identified important differences between fast progressors and people whose disease progresses much more slowly. Dr. Long’s team showed that slow progressors have higher levels of exhausted CD8 T cells — cells that are worn out from attacking the pancreas. The discovery could lead to a test that identifies how quickly individual patients will lose their ability to make insulin.

“Doctors may be able to give ‘fast progressors’ a therapy that’s going to slow down the attacker cells or maybe even stop them,” said Dr. Long, a BRI principal investigator. “For this group of people with type 1 diabetes, that would prolong their ability to make insulin, which makes their lives much easier and significantly reduces their long-term health risks.”

A version of this story originally appeared in the Virginia Mason Health System Annual Report. 

Diabetes Registry Enables Safer, More Thorough Care for Patients

**By Nicholas Moy, MD**

MD PatientAccording to a landmark study published in 2016 in The Lancet, 422 million adults worldwide have diabetes. In the United States alone, diabetes statistics are staggering. According to the Centers for Disease Control and Prevention, in 2015:

  • More than 100 million Americans have diabetes or prediabetes, which if not treated can lead to type 2 diabetes within five years.
  • The percentage of adults with diabetes increased with age, reaching a high of 25.2 percent among those aged 65 years or older.
  • An estimated 1.5 million new cases of diabetes were diagnosed among U.S. adults, with more than half between the ages of 45 and 64.
Understanding diabetes by type

In type 1 diabetes, the body does not produce insulin. Insulin is a hormone the body needs to get glucose (sugar) from the bloodstream into cells. Type 1 is usually diagnosed in children and younger people. However, it can develop at any age. Only about 5 percent of people with diabetes have type 1. Currently, there is no known way to prevent type 1. People with it must inject or pump insulin to survive.

In type 2 diabetes, sometimes called “adult onset,” the body does not use insulin properly, which is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time, it isn’t able to keep up and can’t make enough insulin to keep blood glucose at normal levels. People with type 2 can manage the disease with diet, exercise and medications. In some cases, insulin is needed for management.

Preventing type 2 diabetes

Before people develop type 2 diabetes, they almost always have prediabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

While there is still no cure for diabetes, there is good news: The progression from prediabetes to type 2 diabetes is not inevitable. The National Institutes of Health clinical trial, the Diabetes Prevention Program, found that for people with prediabetes, modest lifestyle changes led to weight loss of 5 to 7 percent in participants and reduced the risk of type 2 diabetes by 58 percent in individuals at high risk.

Diabetes Registry

This is why primary care physicians with Virginia Mason, including myself, developed a Diabetes Registry, which does three important things to help ensure the right care is delivered to the right patients at the right time. First, it identifies patients with diabetes. Second, it identifies how well they are doing. And third, it pulls them back into care when needed.

Although the American Diabetes Association recommends that people with diabetes see a primary care or endocrinology provider every three to six months, life doesn’t always allow that to happen. This is why Virginia Mason’s  Diabetes Registry software is so helpful. It uses algorithms to regularly analyze electronic medical records and alert care teams about who may need follow-up, whether through an appointment or a report to their care team on recent changes, such as with blood pressure, weight loss, etc.

Virginia Mason team members, including medical assistants and nurses, then know to check in with these patients to make sure they are on track. This ensures the care they receive is aligned with their current needs.

“Recently, I was able to get several out-of-care patients in for an appointment and labs with one of our providers,” said Certified Medical Assistant Courtney Yates. “Patients are responding well to the simple reminders we’re sending them, whether they are messages though the patient portal, calls, or mailed letters. Our goal is to get 100 percent of our out-of-care patients back in care.”

Dr Nicholas MoyNicholas Moy, MD, is board certified in Internal Medicine and practices Primary Care at Virginia Mason Hospital and Seattle Medical Center. His special interests include quality improvement and geriatrics.


How Instagram – and Eating Vegan – Is Helping Create a Type 1 Diabetes Patient Community

In today’s socially connected world, people living with medical conditions don’t have far to look to find others sharing their experiences. These growing patient communities have given rise to thousands of websites, blogs, discussion and online groups – all with the goal of sharing ideas and understanding about managing, and even thriving, with medical diseases or disabilities. One unexpected patient online forum emerging today is within Instagram. How does an essentially visual medium create medical communities? I caught up with Michelle Peterson from t1dveganMama to learn how she’s using social media to connect with others who have type 1 diabetes.

What got you started posting on Instagram?

Initially I created an Instagram account to follow my friends’ activities. After a time I started following a few people living with type 1 diabetes (T1D.) I found their posts interesting because they were sharing information about the same things I was experiencing. It was actually my 14-year-old daughter’s idea to set up an Instagram account focused on living with T1D and eating a vegan diet.

What are some of the challenges living with type 1 diabetes?

I have had T1D for 46 years. It is a 24/7/365 disease. There are no breaks. You need to be pay attention to it constantly. While the technology for managing diabetes has improved tremendously over the years, you still need to make smart decisions about what you eat, when you eat, how much you exercise, when you exercise and how much insulin to take. You can do something one day and have beautiful, stable blood sugar levels, and do the exact same thing the next day and have blood sugar levels all over the place.

How long have you been a vegan?

Being vegan is fairly new to me. I tried it off and on in the past, but always missed cheese and seafood. About two months ago I transitioned to a totally vegan diet after my daughter began eating vegan. Now I’m not missing cheese or seafood! My husband has now started eating vegan too, but my two boys are not quite there yet.

Do you have some favorite vegan recipes?

I have found a lot of very good recipes on the Forks Over Knives website. White bean and avocado wraps are a favorite for my family. I also found a banana nut muffin recipe that is a hit.

white bean and avocado wrap

With the holidays coming, big meals and festive gatherings will abound. How do you manage these holiday meals – both as a vegan and a person with diabetes?

When I’m hosting, I don’t plan the entire meal around my diabetes. Nor do I plan to serve everything vegan. I serve a variety of options. I can eat anything; I just need to understand the impact of food on my blood sugar level. Many people think people with diabetes can’t eat sugar. That’s not true. I love this meme that says what people with diabetes can’t eat:

  1. Poison
  2. Cookies with poison

(diabetes humor)

What is your reaction to the growth of your Instagram following?

It’s rewarding. For me, having this network of people trying to manage diabetes well and stay healthy feels very supportive. People share some of the same thoughts about managing diabetes that I have. It’s validating. And, yes, I have T1Ds who are also vegans following me.

What advice do you have for people living with type 1 diabetes?

Make sure you have a good support system. It’s easy to feel alone and like no one understands what you are going through. Type 1 diabetes is often misunderstood, so educate people on what it is and what it isn’t. Be sure to align yourself with an excellent care team that you can reach out to when you need help with managing your diabetes. My last recommendation is that you don’t beat yourself up when your blood sugars are not doing what you want them to do. That’s going to happen, so focus on what you might do next to try to have the best control possible.

You can follow t1dveganmama too! Check out her tips for living with type 1 diabetes and a healthy vegan diet.

And don’t forget — Tuesday, Nov. 14 is World Diabetes Day. Learn more about type 1 diabetes from the American Diabetes Association and the JDRF TypeOneNation T1D support group.