Project summary
Autoantibodies are proteins made by the immune system that signal it has begun to attack the pancreas. People who have two or more types of autoantibodies will almost certainly go on to fully develop type 1 diabetes in their lifetime. Dr Rachel Besser wants to make a list of everyone in the UK who has autoantibodies, called the UK islet autoantibody registry. The aim is to monitor how they progress through the early stages of type 1 diabetes, connect them with clinical trials of new treatments designed to slow down this progression, and understand how best to support them within the NHS.
Background to research
In type 1 diabetes, the immune system attacks and destroys insulin-making beta cells in the pancreas. Warning signs of the attack can begin long before someone develops symptoms of type 1 diabetes and is diagnosed.
These signs are called type 1 diabetes autoantibodies - proteins used by the immune system to earmark beta cells for destruction. They can be detected with a simple blood test.
If people test positive for two or more types of autoantibodies, we say they have early-stage type 1 diabetes. At this point type 1 diabetes has already begun, but people still have normal blood sugar levels and don't yet have symptoms or need treatment.
Over the following months or years, their immune system will continue attacking and destroying more beta cells. Once enough have been lost that they can no longer produce enough insulin, blood sugar levels will rise and type 1 diabetes fully develops.
Right now, research studies - like ELSA and T1DRA - are investigating how best to screen people for autoantibodies, to find those at high risk of developing type 1 diabetes. But we don't currently have a good way of keeping track of everyone who has autoantibodies. This is important, so they can be closely monitored and supported as they progress to a type 1 diabetes diagnosis. And can be alerted to ways to access new treatments, called immunotherapies, designed to hold back the progression of type 1 in its early stages.
Research aims
Dr Rachel Besser and her team at the University of Oxford are making a registry, or a list, of everyone in the UK with type 1 diabetes autoantibodies. Children and adults who’ve tested positive for autoantibodies as part of screening studies can sign up to join the registry, as well as people who’ve been identified by their healthcare team.
The aims of the registry are:
- To keep make it easier for healthcare professionals to monitor people with autoantibodies, to keep an eye on them and catch the onset of type 1 diabetes - and start them on insulin - as early as possible. This will help to prevent dangerous diabetic ketoacidosis at diagnosis.
- To tell people about opportunities to access immunotherapies, that could delay a type 1 diabetes diagnosis.
- To understand what it’s like for people to know they're very likely to one day develop type 1 diabetes, and create ways better to support them.
- To work out new processes in the NHS to care for people with early-stage type 1 diabetes.
- To collect data that will help scientists better understand how type 1 diabetes progresses through its early, pre-symptomatic stages.
Potential benefit to people with diabetes
Dr Besser’s registry could help us to understand the care and support people in the early stages of type 1 diabetes need before a diagnosis, to give them a ‘softer landing’ into life with the condition. It could also help researchers recruit to clinical trials of immunotherapies, allowing them to test treatments faster and find the ones that work, giving us new ways to slow down the progression of type 1, or even prevent it entirely.
