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 an attack by the immune system on the cells in the pancreas that control blood sugar levels.

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

They say newly developed drugs may 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 from Merseyside suddenly fell ill on Halloween 2018. It all started with a mild cold, but quickly escalated.

“She went from a very happy one-year-old girl, going to nursery, dancing and singing, to almost dying in less than 48 hours,” says father Gareth.

“The diagnosis remains 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: monitoring everything Gracie ate and drank, checking her blood sugar levels and administering the hormone insulin to force her body to absorb sugar from the blood.

Gracie now has a glucose meter and an insulin pump and is “taking control of her diabetes,” her father says.

“Gracie is a superstar,” he adds.

But why do children diagnose young people like Gracie? especially those under seven years oldhave a more aggressive disease than those diagnosed in adolescence or later remains a mystery.

A study published in the journal Science Advances shows that this is due to the development of beta cells living in the pancreas.

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

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

These beta cells were previously shown to exist as small clumps or individual cells, but with age their numbers increase and they mature into larger groups known as islets of Langerhans.

The study looked at what happened after the immune system turned against a patient's own beta cells.

Beta cells in small groups were selected and destroyed, so they did not have a chance to mature.

Those on larger islets were still attacked but were more resistant, allowing patients to still produce low levels of insulin, reducing the severity of their disease.

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

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

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

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

“Because we have new drugs to treat type 1 diabetes in children, we hope that they will be able to prevent or delay its development in these young people,” Dr. Richardson said.

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

Rachel Connor, director of the Breakthrough T1D Research Partnership, said: “This study gives us the missing piece of the puzzle to explain why type 1 diabetes progresses so much faster in children than in adults.”

Dr Elizabeth Robertson, director of research and clinical development at Diabetes UK, said: “Unraveling 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 more precious years without insulin therapy and, one day, preventing the need for it entirely.”