Type 1 diabetes was once known as “juvenile diabetes,” affecting mainly children with a peak incidence between 6 and 8 years of age and up to age 14.
Today, however, type 1 diabetes looks quite different.
In fact, according to Dr. Anna Casu, endocrinologist, Associate Investigator and von Weller Family Chair of Type 1 Diabetes at the AdventHealth Translational Research Institute, “New data suggests that almost half of people diagnosed with type 1 diabetes are age 30 or over, and a main focus of our research is aimed at finding out the disease mechanisms to determine why this is happening. One of them might be obesity.”
She adds, “In addition, we are trying to identify new markers that can help diagnose adult-onset type 1 diabetes and predict how fast the progression will be.”
Why Type 1 Diabetes in Adults is Often Misdiagnosed
Adult-onset type 1 diabetes is often misdiagnosed in adults after standard of care treatment for type 2 diabetes is not successful, leading to additional and more specific diagnostic testing.
Dr. Casu describes, “A diabetes diagnosis is made when the blood glucose is higher, or there are mild symptoms like increased urination or thirst. Most adults are first diagnosed as having type 2 diabetes. Patients with adult onset type 1 diabetes, however, tend to be unresponsive to the standard treatment and may also be of a leaner body weight. These factors lead their physician to believe it’s something else and prescribe blood tests that result in diagnosing type 1 diabetes instead.”
To diagnose type 1 diabetes, antibody testing is done to determine if the person’s immune system is attacking the insulin-producing cells. If the antibodies are positive, it means they could have type 1 diabetes and progress to insulin requirement faster.
“There is an autoimmune component to type 1 diabetes; the immune system is attacking its own insulin-producing cells. Right now, we don’t know what causes that,” Dr. Casu states.
Having a family history of type 1 diabetes or a preexisting autoimmune condition, such as celiac disease, could be predisposing factor. Obesity is adding to this. We are studying if it could also be causative.
Why Early Diagnosis is Important for Type 1 Diabetes
“Patients that are not properly diagnosed don’t get the proper treatment, or treatment that’s not as effective, so there is a delay in achieving proper control of the disease. We’re working on understanding why people are developing type 1 diabetes later to understand the mechanisms so we can identify at-risk populations and even develop treatments to slow the fast onset,” shares Dr. Casu.
The AdventHealth Translational Research Institute strives to discover new ways to provide better diabetes treatments to the community.
“We have a lot of potential to provide the most appropriate diagnosis and treatment to the right people that have type 1 diabetes,” notes Dr. Casu.
And Dr. Casu is personally invested in this topic. She herself was diagnosed with type 1 diabetes in childhood.
Dr. Casu’s Journey and Inspiration to Help Others
“I was always interested in research and since I was a little girl, I wanted to do something difficult in my life — to prove I was strong enough. My mom always told me that I shouldn’t be less than anybody else and that my diabetes should not prevent me to reach my goals.” she shares.
Dr. Casu continued her quest for nothing but the best. She attended medical school with the continued fervor to devote her career to research. She had the opportunity to work with an endocrinologist as a student researcher and that sparked her love for research in type 1 diabetes specifically.
“I think being a type 1 diabetic has helped me in understanding patients — as a doctor and researcher.”
She recounts that when she was diagnosed, there were no insulin pumps — only a syringe with mixed porcine insulin (not human recombinant insulin). She explains that there were no glucose sensors and blood sugar was only checked through urine at the time.
But today, hybrid artificial pancreases are a reality.
This reflection is a testament to how far we’ve come with type 1 diabetes, yet how far we have to go. And research has and always will be the catalyst for these advances.
“There are so many things that research has changed with time. I am always reminded of that. Years and years of research has led to almost automatic systems for monitoring blood sugar and delivering insulin for people with type 1 diabetes,” she says.
All of these advances lead to improved health outcomes, but also an enhanced ability to live a full life.
Dr. Casu’s Involvement in Research for New Type 1 Diabetes Discoveries
“The AdventHealth Translational Research Institute is involved in many studies, including national ones, that are focused on finding better treatments for type 1 diabetes,” she says.
One area of specialty is in obesity and type 1 diabetes. With the prevalence of diabetes rising in both children and adults, Dr. Casu and other researchers are striving to understand the mechanism by which obesity contributes to type 1 diabetes and the mechanisms related to insulin treatment.
Translating Research to Practice
With a close partnership between the vast AdventHealth system, there’s collaboration between the research at the AdventHealth Translational Research Institute and other institutes, centers and specialties within the network. This not only assists with providing patients with more trial options, but also offering evidence-based treatments when new discoveries are made.
“The goal of translational research is to transfer what we find in basic research to the people — offering safe and effective treatment options.”
Dr. Casu adds, “Additionally, the AdventHealth Translational Research Institute is a screening center for the national TrialNet type 1 diabetes study in first degree relatives and has contributed to studies about the use of continuous glucose monitors, which could lead to a wider application of life-improving technology.”
It’s important to add that studies are only possible with the participants that volunteer to be a part of the clinical trials. If you’re interested in participating in a trial, follow this link for more information.