Prevention research

To prevent type 1 diabetes, we need to fix the immune system fault that lies at the heart of the condition. There are two areas of prevention research. The first aims to prevent the immune system from ever targeting insulin-producing cells. The second focuses on halting the immune system attack after it has begun but before a person needs to take insulin.

Research to prevent the immune system attack

Truly preventing type 1 means stopping the immune system going awry in the first place, which is sometimes called ‘primary prevention’. This would mean preventing the immune system from attacking and destroying insulin-producing beta cells.

To do this we need to know what causes type 1 to develop in the first place.

Understanding what causes type 1

The first step in working out how to prevent type 1 is to understand how it begins in the first place. Read more about the causes of type 1 diabetes.

Our researchers are unpicking what happens in someone’s body before they start needing insulin. This work ranges from growing groups of cells to model type 1 diabetes in the lab to examining pancreas samples donated by people with type 1.

A whole strand of the Type 1 Diabetes Grand Challenge is dedicated to finding the root causes of the condition. Plus, our Connect Immune Research partnership brings together several autoimmune research funding organisations to hunt for clues as to how autoimmune conditions develop.

Do our genes cause type 1 diabetes?

Thanks to research, much of it funded by Breakthrough T1D UK, we now know of over 50 genes that can influence our risk of type 1 diabetes. But we are still trying to understand why some people with the same genetic risk factors go on to develop type 1, while others don’t.

Could a viral infection cause type 1 diabetes?

There is growing evidence that several different viruses may have a role in triggering type 1. We don’t yet know if this is due to specific viruses or whether getting a virus overloads an already struggling immune system. Lots of researchers are working hard to understand more about the potential link between viruses and type 1.

Research to halt the immune system attack

The other type of prevention research (sometimes known as ‘secondary prevention’) looks at how to halt the immune system attack once it has already begun. This research is about preventing the need for insulin therapy, not preventing the earliest stages of the immune attack.

This type of research is very similar to immune research to cure type 1. The only difference is in the timing of when the treatment is to be given – before or after someone begins needing to take insulin.

It’s a race against time

Once the immune attack on a person’s insulin-producing cells has begun, it’s a matter of time before they develop clinical type 1 diabetes. People go through two stages of type 1 diabetes before they are diagnosed in stage 3 or clinical type 1 diabetes. This is when enough of a person’s beta cells are damaged that they need external insulin to manage their glucose levels. Research tells us this might be as fast as a few months in some people, but could take several decades in others.

Screening for type 1 diabetes

If we can identify people who are experiencing the autoimmune attack before they need insulin, we might be able to prevent them ever needing insulin treatment at all. Researchers across the world are investigating the best ways to screen populations to find those in the earliest stages of type 1 before they experience symptoms.

Find out how Professor Parth Narendran is screening UK children for type 1, in a study co-funded by Breakthrough T1D UK. You can also learn about Professor Richard Oram’s Breakthrough T1D UK-funded research to develop a combined risk score for type 1.

Learn more about screening for type 1 diabetes.

Boosting the protective function of the immune system

This area of research involves developing new treatments to retrain the immune system not to attack beta cells. We know that a healthy immune system usually prevents autoimmunity using its own specialised police of cells which make sure the immune system can’t damage healthy cells.

Breakthrough T1D UK-funded researchers have shown that people with type 1 have fewer police cells, which allows the autoimmune reaction to continue uncontrolled. Researchers are now looking for ways to harness this knowledge to strengthen the systems that prevent autoimmunity in people at risk of developing type 1.

Immune therapies targeting the immune attack

Immune therapies, which are treatments that interfere with the attack by the immune system on beta cells, are emerging thick and fast. We are funding clinical trial networks, including the UK T1D Research Consortium, INNODIA and T1D Plus, to test potential immune therapies faster and more effectively.

A drug called teplizumab is licensed for people in the earliest stages of type 1 in the US. Teplizumab can currently delay type 1 by up to three years by slowing down the immune attack on beta cells. Researchers hope they can continue to increase this delay period, first long enough that type 1 no longer affects children, and then no one at all.

Find out more about immune therapies for type 1 diabetes.

How does prevention research help us treat type 1 diabetes?

Many of the drugs being tested in people in the earliest stages of type 1 before they need insulin (known as preclinical type 1 diabetes) are also being trialled in people newly diagnosed with type 1. This is because you still have some beta cells remaining when you are diagnosed with type 1 and may continue to for many years after.

According to Breakthrough T1D UK-funded researcher Professor Colin Dayan, ‘keeping even 5% of beta cell function makes glucose control with injected insulin much smoother and makes it easier to avoid hypoglycemia’. You can read more about Colin’s research to improve and run clinical trials of immune therapies.

How does prevention research help us find a cure for type 1?

Prevention research focuses on understanding and controlling the immune system. Several Breakthrough T1D UK-funded research projects to cure type 1 diabetes are trying to replace or regrow the insulin-producing beta cells. However, whatever caused the immune system to attack someone’s original beta cells will attack these replacement cells. So, preventing this immune attack could also form part of a cure for type 1.

Find out more about our cure research.