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Research looks to end mystery around Type 1 diabetes

What if something readily available at your neighborhood drugstore could potentially save your child from a lifetime of Type 1 diabetes (T1D)? That’s what researchers from Children’s Wisconsin and the Medical College of Wisconsin are trying to confirm. Their hypothesis is that probiotics — yes, the kind you can buy over the counter — can help prevent T1D.

What is T1D?

Insulin is a hormone produced in the pancreas that allows your body to use or store sugar for energy. For people with T1D, their immune system attacks and destroys the insulin-producing cells in the pancreas. Because of this, they cannot make their own insulin and are dependent on taking it through an injection or insulin pump multiple times a day. People with T1D must regularly monitor their blood sugar to prevent life-threatening low blood sugar or harmful high blood sugar levels.

Unfortunately, like other autoimmune conditions, T1D has become more common in the past few decades. Every year, the number of people diagnosed with T1D increases by two to three percent. While T1D can occur at any age, it is most likely to be diagnosed in children. Children’s Wisconsin diagnoses more than 250 children with T1D every year and our Diabetes Clinic provides care for nearly 2,000 children with T1D.

T1D cause

Most people diagnosed with T1D are the first in their family to develop the condition, but once it’s in the family, other first-degree relatives are 10 times more likely to develop T1D. Why? That’s something researchers are helping pinpoint.

Over the past 15 years, Children's Wisconsin and the Max McGee Research Center for Juvenile Diabetes at the Medical College of Wisconsin have been collecting blood samples in children with T1D, and comparing them to those of healthy unrelated children and adults. Researchers have found the immune systems of people with T1D are inflamed. Interestingly, the immune systems of their healthy siblings (i.e., siblings without diabetes) are also inflamed.

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The immune system has two major features — inflammation and regulation. Inflammation is the body’s way of protecting itself against infection or injury by increasing the production of white blood cells.

Susanne Cabrera, MD, from Children’s Wisconsin and the Medical College of Wisconsin said, “Our research has shown that the healthy siblings who remain T1D-free have put the brakes on inflammation before it can become a problem. Conversely, siblings who develop T1D are unable to handle the inflammation, which then progresses until they develop T1D.”

Bacteria as a factor

Bacteria can help or hurt the body — some help our immune system while others drive inflammation. And there are as many bacteria in our intestines as there are human cells in our body. The kinds of bacteria we have living in our intestines is determined by our genetics as well as our outside environment, like our diet and the types of medications we take.

Food interacts with the billions of bacteria living in the intestines to either help or hurt the immune system. The kinds of foods most of us eat as part of the typical western diet are low in fiber and heavily processed, encouraging the growth of “bad” or “inflammatory” bacteria. Similarly, antibiotics and other medications may encourage the growth of inflammatory bacteria.

Martin Hessner, PhD, from Children’s Wisconsin and the Medical College of Wisconsin said, “People with T1D have an imbalance in the good and bad bacteria. This imbalance may cause inflammation and make the lining of the intestines ‘leaky,’ which allows bacteria to enter the blood stream. This aligns with the findings that people with T1D and their family members have inflammation driven by intestinal signals — we believe that the bad bacteria are signaling inflammation, passing through the intestines and causing inflammation within the pancreas, resulting in T1D.”

Based on these findings, researchers believe they may be able to prevent T1D by either reducing the inflammation seen in T1D family members and/or speeding up the immune regulation so the brakes are applied as quickly and strongly as possible.

Prevention

Currently, there is no cure or prevention for T1D, but the team at the Max McGee Research Center for Juvenile Diabetes are working to change that. Researchers are interested in environmental exposures that may be increasing the risk of T1D, especially those we may be able to change to prevent disease.

They hypothesize that regaining a healthy balance of bacteria in people at risk for T1D (those with family members that have T1D) may help prevent the disease.

Probiotics are thought to be one way of regaining helpful or “anti-inflammatory” bacteria. Probiotics are living bacteria that can supplement our diet and restore healthy populations of intestinal bacteria.

Potential power of probiotics

Dr. Cabrera said, “In the last two years, we have investigated the role of probiotics in T1D families and recently were awarded a grant from the Children’s Wisconsin Research Institute to test the role of probiotics in reducing the inflammation known to occur in T1D families.”

For the investigation, the team gave a probiotic supplement to 25 healthy children and teenagers every day for six weeks. These children and teenagers had a sister or brother with T1D and were at higher risk than the general population of getting T1D. Researchers collected blood and stool samples before and after the six-week probiotic course, while collecting information about previous antibiotic use and general food consumption patterns to help us put our findings in context. While the data is still being analyzed, they did find something interesting — after only six weeks of taking a probiotic, children had blood levels that indicated less inflammation.

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Dr. Hessner said, “We do not yet know if the reduction in inflammation will translate to a lower risk of developing diabetes, but studies to fully assess that question are now being planned. To further our investigation of the role of probiotics in T1D, the Max McGee Research Center for Juvenile Diabetes was just awarded a grant from the American Diabetes Association to examine if probiotics can help children recently diagnosed with T1D make their own insulin longer.”

Researchers hypothesize that probiotics will reduce overall inflammation in children with recent onset T1D and this will translate to better insulin production by the child’s remaining cells.

Since longer periods of insulin production is associated with a lower rate of diabetes complications and severe low blood sugars, probiotics may be a useful and safe way to make the disease less dangerous. This study aims to enroll 45 subjects over the next three years and researchers just started recruiting.

Investigations into the environmental factors driving T1D risk have also extended to the study of artificial sweeteners and “prebiotics” –– the building blocks in our diet that intestinal bacteria eat such as fiber, gluten and other wheat proteins.

If they find that these are in fact a contributor to T1D, it won’t require an expensive or complicated treatment. Each of these things can be easily and safely changed in a diet. It’s their hope that something so easy to do can truly help prevent children from getting or help them manage a potentially deadly disease. 

 

If you’re interested in learning more about the research, contact research coordinators at 414-955-4903 or email them at T1Dinfo@mcw.edu. Interested parties can also visit mcw.edu/diabetes. Never under-estimate the power of participating in research as someone impacted by the disease or as a healthy control!