Soon it may be possible to learn the immune system to recognize insulin while not triggering the symptoms of type 1 diabetes. In the UK, a new study has been launched, coordinated by Oxford University researchers, involving thousands of children, who will be receiving oral insulin from the very first months of life. We discuss this with Dr. Marco Mirani, a diabetologist at Humanitas.
Symptoms of diabetes type 1
Diabetes type 1 is a disease that manifests itself mainly from a young age, and for this reason it is called childhood diabetes. This disease falls into the category of autoimmune diseases and is caused by the production of autoantibodies that attack and destroy the beta cells within the pancreas that are responsible for the production of insulin, not recognizing them as belonging to the body. As a result, the production of this hormone, whose task is to regulate the use of glucose by the cells, is reduced to zero. The excess of glucose in the blood thus results in hyperglycemia and the scarcity of insulin prevents the body from using glucose to produce the energy necessary for its operation.
The main clinical symptoms of diabetes type 1 are: polyuria (increased volume of urine), polydipsia (increased thirst) and polyphagia paradox (weight loss not due to changes in diet).
Often the symptom of type 1 diabetes onset is a serious condition due to the accumulation of ketone bodies secondarily to the lack of insulin, such a clinical situation known as diabetic ketoacidosis if not treated promptly can also be fatal.
In some cases there is also a normalization of the blood sugar even if there is no therapy right after the onset phase , a transitional condition, known as “honeymoon”, which can last only a few months. After this short period, the symptoms reoccur and remain stable, giving origin to the actual disease.
A test for 30,000 children
The researchers have arranged one genetic test to be administered to 30,000 newborn children: the aim will be to understand if the subjects chosen have the genetic mutations that predispose to type 1 diabetes, which are usually present in one child out of a hundred. The children will then be divided into two groups, one of which will be periodically given oral insulin between six months and three years of age. The other group will receive a placebo. The basic idea behind the test is to check whether it is possible to get the immune system used to insulin, avoiding the symptoms of type 1 diabetes, which usually occur during childhood. “Preventing children and their families from living with diabetes and its complications such as blindness and kidney or heart problems would be great,” said Matthew Snape, the study coordinator.
The perspective in Italy
“According to the most recent estimates in Italy there are 18,000 children and adolescents suffering from type 1 diabetes, and forced to administer insulin through injections (four but also six times a day) or the use of pumps. While the Ministry of Health has a total of about 300,000 Italians, young and old, with type 1 diabetes – explained Dr. Mirani – numbers that amply demonstrate the social impact that this disease also affects our country and on whom unfortunately at the present time we can intervene only by “curing” and not “preventing”. With this study, the objective becomes precisely prevention: to identify children at greater risk of type 1 diabetes at birth, by carrying out genetic screening, and to intervene by administering insulin orally to induce immune tolerance and prevent the development of autoimmunity that subsequently leads to type 1 diabetes. Although when we talk about the immune system, due to its complexity, we must always be very careful, because if this research will have the desired results we would really be facing a momentous turning point in the treatment of this disease.
