How might clinicians find optimal candidates for novel type 1 diabetes therapies?
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Leverage type 1 diabetes networks while increasing provider and community education.
Guidance on staging pre-symptomatic type 1 diabetes was published in 2015; however, the guidance is not always top of mind in primary care or even in specialty care. Yet, we know as many as 90% of people who go on to develop type 1 diabetes have no family history of type 1 diabetes.
There are research pathways right now in the United States and internationally to find candidates for therapy trials; however, sometimes people are not eligible for those pathways.
That is why T1Detect is such an essential program. It is a community-based education and awareness program recently launched by JDRF to expand screening to the general population. The program’s aim is to help people understand what type 1 diabetes is, how screening is advantageous to the public, how they can be involved and what to do if they are positive for autoantibodies. When the day comes when we do have FDA-approved therapies, we want a robust pipeline we can get more people through, with strong policies in place.
Through T1Detect, we are thinking about pathways to population-level screening. That is not in the guidelines yet, but the conversation must start now. We need to rely on established networks, but we need to be thinking as a community that wants to prevent type 1 diabetes, or at least delay the diagnosis given that we potentially have that option.
Education — not just in the general community, but in the health care community — is key before you screen, when you screen and after a person is screened for type 1 diabetes. The focus of JDRF is on education and awareness. We want to be a partner in the community with people who are already doing this work.
- Reference:
- Insel RA, et al. Diabetes Care. 2015;doi:10.2337/dc15-1419.
- Anastasia Albanese-O’Neill, PhD, APRN, CDCES, is director of community screening and clinical trial education at JDRF and an Endocrine Today Editorial Board Member. Sanjoy Dutta, PhD, is vice president of research for JDRF.
Screening, building partnerships will help raise awareness.
Teplizumab is only the tip of the iceberg when it comes to type 1 diabetes prevention. There are therapies we have been testing in people with new-onset, stage 3 type 1 diabetes, which we now need to test in the prevention space. We still need to learn which of these therapies is most effective, how they might work with other therapies and whether there will be a stratification of therapies.
These questions are why we need to start screening for type 1 diabetes. You need a large population to conduct prevention trials and to assess the cost-effectiveness for prevention. Teplizumab (Provention Bio) on its own may not be cost-effective. However, if we give teplizumab and, for example, another T-cell agent in combination, we could see a much longer delay of disease onset for a much greater proportion of people. Then we have cost-effective treatment.
Teplizumab has opened a door. Now we need the population to drive these other studies to get more answers. Screening people with first-degree relatives with type 1 diabetes will not give us the numbers we need. We must move to the general population and start educating health care professionals about type 1 diabetes.
A screening is never perfect. We are still not screening everyone for things like colon and breast cancer. Getting more people screened will cost exponentially more but can also prevent diabetic ketoacidosis for many people at risk for type 1 diabetes.
This is just a first step. As these types of therapies move closer to reality for people with type 1 diabetes, we must build relationships with many different groups: community pharmacists, schools, vaccination programs, district nurses, and even health economists, population scientists and behavioral scientists. Building these relationships right now — before these treatments are approved — will position us well to raise awareness and educate the larger community.
- Parth Narendran, PhD, FRACP, is professor of diabetes medicine and honorary consultant physician at the Institute of Immunology and Immunotherapy at University of Birmingham Medical School. He leads the diabetes research unit and the type 1 diabetes clinical service at Queen Elizabeth Hospital.
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