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Clinical trials, beta-cell preservation approach urged for type 1 diabetes
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Determining tolerable approaches to preserve beta-cell function in patients with type 1 diabetes, particularly those who are newly diagnosed, through large-scale trials is a critical need, according to a paper published in Diabetologia.
Researchers in the United Kingdom, where the autoimmune form of the condition reportedly affects as many as one in 300 people, reviewed research on how physical exercise affected other models and offered possible mechanisms to support its therapeutic use.
“The last 30 years have seen a number of largely unsuccessful trials for beta-cell preservation, and with therapies that have potential for harm,” Parth Narendran, PhD, MRCP, of the University of Birmingham, said in a press release. “There is a need to explore … ones that can be implemented on a large clinical scale. Exercise could be an ideal example of such an approach.”
Parth Narendran
Narendran and colleagues from other institutions looked at 18 studies conducted in individuals without diabetes (seven studies), with abnormal glucose tolerance (three studies) and with type 2 diabetes (eight studies).
The researchers’ evidence covered the relationships between exercise and beta-cell proliferation. “Physical exercise elicits marked elevations in circulating levels of growth hormone, insulin-like growth factor, glucagon-like peptide, interleukin 6 and interleukin-1 receptor agonist, all of which are thought to have a preserving effect on beta-cell mass,” they wrote.
The investigators also emphasized the associations between exercise and beta-cell death, including decreases in circulating concentrations of leptin and tumor necrosis factor-alpha and increases in circulating adiponectin.
“Switching the cytokine environment to an anti-inflammatory profile could potentially modulate the immune response that leads to beta-cell destruction in type 1 diabetes,” they wrote.
The researchers pointed to beneficial effects of exercise in Graves’ thyroid disease, in which cells are similarly under autoimmune attack.
Although evidence has shown exercise promotes fitness and reduces insulin requirement and resistance in patients with type 1 diabetes, the researchers underscored potential fluctuations in glucose levels could factor into patients exercise choices.
“If exercise is shown to salvage residual beta-cell function, there would be a strong argument to implement it much earlier in the natural history of this condition, and to develop strategies to encourage and support patients at this time,” the researchers wrote. “As a therapy, its attraction lies in the many health benefits it accrues, but also because it could be instituted alone, or as a combination therapy for beta-cell preservation in type 1 diabetes.”
The researchers report work on a preliminary pilot study of exercise in patients with type 1 diabetes, which they hope will forward the design of large-scale trials in new-onset cases.
Disclosure: The researchers report no relevant financial disclosures.
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