6/25/2013
Early Detection of Type 1 Diabetes
New Research Presented by Berrie Center Clinical Investigators

Thousands of families have participated in the Berrie Center’s type 1 diabetes (T1D) screening program as part of the NIH TrialNet Pathway to Prevention Research Study. Only 5% of people who are screened for T1D have the pancreatic antibodies that indicate a higher risk of getting the disease. “Screening may provide peace of mind to anyone at risk for developing T1D, and can lead to participation in prevention trials for those people who show no outward sign of having T1D, but are found to have the disease,” said Ellen Greenberg, Lead Research Coordinator for Type 1 Diabetes Clinical Trials.

“Screening provides critical data to scientists that will answer questions about the causes of type 1 diabetes, how the disease progresses, and how we might be able to prevent it from occurring,” shared Scott Chosed, dad of Maxwell, who has T1D and receives his treatment at the Berrie Center. Maxwell’s mom, Sabrina, added, “When the Berrie Center asked us to participate in the Pathway to Prevention study, we did not hesitate to have ourselves and Maxwell’s two brothers screened.”

One of the many interesting outcomes of the study is that investigators have identified a category of T1D that they know very little about. Called “silent diabetes”, it is a diagnosis given to people who have no symptoms at all—but are discovered through the screening to be in the early stages of the disease.

“This is important for many reasons,” said Rachelle Gandica, MD, a pediatric endocrinologist at Columbia’s Naomi Berrie Diabetes Center. “Ordinarily, people are diagnosed with new-onset T1D because they have symptoms of very high blood sugar and are often sick. What TrialNet screening allows us to do is identify people with T1D before they get sick. It is the early detection of type 1 diabetes and it is really very exciting. ” 

Dr. Gandica is the lead author on a study conducted by clinical investigators at the Berrie Center on the diagnosis and treatment of people with silent T1D. Preliminary results of this study were presented this week in Chicago at the 73rd Scientific Sessions of the American Diabetes Association

Said Dr. Gandica, “Because it’s so new, we really don’t have any guidelines for how to treat people with asymptomatic T1D. We’re looking to see how clinicians at the Naomi Berrie Diabetes Center have treated these patients at diagnosis and as time goes on. Do we start insulin at diagnosis and, if not, when is insulin started?” The clinical research team at the Berrie Center plans to expand their study to include data from the entire network of centers participating in the multi-center TrialNet Pathway to Prevention Study. 

The study begins by screening people who are at risk for T1D—the parents, siblings, children, aunts, uncles, nieces, nephews and cousins of people who already have it—with a simple blood test that looks for pancreatic auto-antibodies, or markers that the immune system’s assault on the beta cells has already begun. Subjects who test positive for one or more antibodies (five different antibodies are measured) will be re-tested and may undergo glucose tolerance testing. Individuals are considered to have “silent” T1D when glucose levels are abnormal, but they are without any symptoms. Another proposed name for this condition is “biochemical diabetes.”

There are a number of T1D prevention trials available to people who test positive for these antibodies. The Berrie Center currently administers three such trials and is preparing to launch a fourth trial next year. 

Dr. Gandica believes that detecting T1D early, prior to development of the high blood sugars that cause symptoms, offers an excellent opportunity for studying strategies that may delay diabetes progression. “Ultimately,” she said, “the hope is that we will be able to halt T1D completely and have it never progress.”

Contact the Berrie Center at 212-851-5466 or eal2179@columbia.edu to learn more about TrialNet Pathways to Prevention T1D screening.

Click here to support clinical trials and screenings at the Berrie Center.