Type 1 diabetes may develop more slowly than thought

The pancreas continues to produce insulin at some level decades after onset of the disease, a new study shows.

By — Posted March 7, 2012

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Recent data showing that type 1 diabetes progresses more slowly than formerly thought is expected to help physicians better manage the condition in their patients, according to the lead author of a recent study.

Traditionally, it was believed that the production of insulin by beta cells completely ceased in people with advanced type 1 diabetes, said Denise L. Faustman, MD, PhD, director of the Immunobiology Laboratory at Massachusetts General Hospital in Boston.

But a study in the March Diabetes Care shows that the pancreas continues to function and produce insulin at some level even decades after the onset of type 1 diabetes. Dr. Faustman was lead author of the study.

Determining how much insulin a diabetic patient is producing, regardless of how small an amount, will help physicians better regulate the individual's blood glucose levels and delay the potential development of medical complications, Dr. Faustman said. Such complications include cardiovascular problems, neuropathy and osteoporosis.

The recent findings will help physicians more accurately determine which diabetic patients need external assistance, such as an insulin pump, and it will enable them to give people newly diagnosed with the disease a more optimistic outlook, Dr. Faustman said.

"The message for patients is, 'It's not over,' " she said.

"Diabetes is kind of a depressing disease. You get the diagnosis and then you start to have regular appointments and the doctor often tells you, 'You're doing a bad job controlling your glucose levels,' " Dr. Faustman said. She added that the study's findings should help change this.

About 19 million U.S. children and adults have been diagnosed with diabetes, according to the American Diabetes Assn. Among adults, type 1 diabetes accounts for up to 10% of the diagnoses, the Centers for Disease Control and Prevention said.

Researchers for the Diabetes Care study examined serum samples from 182 people with type 1 diabetes using an ultrasensitive assay for C-peptide, which is a marker of insulin. The participants, age 8 through 75, were patients at Massachusetts General Hospital.

Researchers found that C-peptide levels were lower among those who had diabetes for a greater number of years (link).

But the decrease of C-peptide over time was gradual rather than abrupt, the study shows. Even among patients who had the disease for 31 to 40 years, 10% still produced C-peptide, the study authors said.

They also found that beta cells continue to function even when C-peptide levels are very low.

"Our results contribute to a growing body of evidence suggesting there might be a longer window for therapeutic intervention in this disease," Dr. Faustman said.

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