scholarly journals Baseline Assessment of Circulating microRNAs Near Diagnosis of Type 1 Diabetes Predicts Future Stimulated Insulin Secretion

2020 ◽  
Author(s):  
Isaac Snowhite ◽  
Ricardo Pastori ◽  
Jay Sosenko ◽  
Shari Messinger Cayetano ◽  
Alberto Pugliese
Keyword(s):  
Clinical Trials ◽  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Tolerance Test ◽  
Circulating Micrornas ◽  
C Peptide ◽  
Impaired Insulin

Type 1 diabetes is an autoimmune disease resulting in severely impaired insulin secretion. We investigated whether circulating microRNAs (miRNAs) are associated with residual insulin secretion at diagnosis and predict the severity of its future decline. We studied 53 newly diagnosed subjects enrolled in placebo groups of TrialNet clinical trials. We measured serum levels of 2,083 miRNAs using RNAseq technology, in fasting samples from the baseline visit (<100 days from diagnosis), during which residual insulin secretion was measured with a mixed meal tolerance test (MMTT). Area under the curve (AUC) C-peptide and peak C-peptide were stratified by quartiles of expression of 31 miRNAs. After adjustment for baseline C-peptide, age, BMI and sex, baseline levels of miR-3187-3p, miR-4302, and the miRNA combination of miR-3187-3p/miR-103a-3p predicted differences in MMTT C-peptide AUC/peak levels at the 12-month visit; the combination miR-3187-3p/miR-4723-5p predicted proportions of subjects above/below the 200 pmol/L clinical trial eligibility threshold at the 12-month visit. Thus, miRNA assessment at baseline identifies associations with C-peptide and stratifies subjects for future severity of C-peptide loss after 1 year. We suggest that miRNAs may be useful in predicting future C-peptide decline for improved subject stratification in clinical trials.

scholarly journals Baseline Assessment of Circulating microRNAs Near Diagnosis of Type 1 Diabetes Predicts Future Stimulated Insulin Secretion

2020 ◽  
Author(s):  
Ada Admin ◽  
Isaac Snowhite ◽  
Ricardo Pastori ◽  
Jay Sosenko ◽  
Shari Messinger Cayetano ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Tolerance Test ◽  
Circulating Micrornas ◽  
C Peptide ◽  
Impaired Insulin

Type 1 diabetes is an autoimmune disease resulting in severely impaired insulin secretion. We investigated whether circulating microRNAs (miRNAs) are associated with residual insulin secretion at diagnosis and predict the severity of its future decline. We studied 53 newly diagnosed subjects enrolled in placebo groups of TrialNet clinical trials. We measured serum levels of 2,083 miRNAs using RNAseq technology, in fasting samples from the baseline visit (<100 days from diagnosis), during which residual insulin secretion was measured with a mixed meal tolerance test (MMTT). Area under the curve (AUC) C-peptide and peak C-peptide were stratified by quartiles of expression of 31 miRNAs. After adjustment for baseline C-peptide, age, BMI and sex, baseline levels of miR-3187-3p, miR-4302, and the miRNA combination of miR-3187-3p/miR-103a-3p predicted differences in MMTT C-peptide AUC/peak levels at the 12-month visit; the combination miR-3187-3p/miR-4723-5p predicted proportions of subjects above/below the 200 pmol/L clinical trial eligibility threshold at the 12-month visit. Thus, miRNA assessment at baseline identifies associations with C-peptide and stratifies subjects for future severity of C-peptide loss after 1 year. We suggest that miRNAs may be useful in predicting future C-peptide decline for improved subject stratification in clinical trials.

scholarly journals Baseline Assessment of Circulating microRNAs Near Diagnosis of Type 1 Diabetes Predicts Future Stimulated Insulin Secretion

2020 ◽  
Author(s):  
Isaac Snowhite ◽  
Ricardo Pastori ◽  
Jay Sosenko ◽  
Shari Messinger Cayetano ◽  
Alberto Pugliese
Keyword(s):  
Clinical Trials ◽  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Tolerance Test ◽  
Circulating Micrornas ◽  
C Peptide ◽  
Impaired Insulin

Type 1 diabetes is an autoimmune disease resulting in severely impaired insulin secretion. We investigated whether circulating microRNAs (miRNAs) are associated with residual insulin secretion at diagnosis and predict the severity of its future decline. We studied 53 newly diagnosed subjects enrolled in placebo groups of TrialNet clinical trials. We measured serum levels of 2,083 miRNAs using RNAseq technology, in fasting samples from the baseline visit (<100 days from diagnosis), during which residual insulin secretion was measured with a mixed meal tolerance test (MMTT). Area under the curve (AUC) C-peptide and peak C-peptide were stratified by quartiles of expression of 31 miRNAs. After adjustment for baseline C-peptide, age, BMI and sex, baseline levels of miR-3187-3p, miR-4302, and the miRNA combination of miR-3187-3p/miR-103a-3p predicted differences in MMTT C-peptide AUC/peak levels at the 12-month visit; the combination miR-3187-3p/miR-4723-5p predicted proportions of subjects above/below the 200 pmol/L clinical trial eligibility threshold at the 12-month visit. Thus, miRNA assessment at baseline identifies associations with C-peptide and stratifies subjects for future severity of C-peptide loss after 1 year. We suggest that miRNAs may be useful in predicting future C-peptide decline for improved subject stratification in clinical trials.

scholarly journals Low-dose ATG/GCSF in Established Type 1 Diabetes: A Five-Year Follow-up Report

2021 ◽  
Author(s):  
Andrea Lin ◽  
Jasmine A. Mack ◽  
Brittany Bruggeman ◽  
Laura M. Jacobsen ◽  
Amanda L. Posgai ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Low Dose ◽  
Area Under The Curve ◽  
Tolerance Test ◽  
Modeling Framework ◽  
C Peptide ◽  
Recent Onset

Previously, we demonstrated low-dose anti-thymocyte globulin (ATG) and granulocyte colony stimulating factor (GCSF) immunotherapy preserved C-peptide for two years in a pilot study of subjects with established type 1 diabetes (n=25). Herein, we evaluated the long-term outcomes of ATG/GCSF in study participants with five years of available follow-up data (n=15). The primary endpoint was area under the curve (AUC) C-peptide during a two-hour mixed-meal tolerance test (MMTT). After five years, there were no statistically significant differences in AUC C-peptide when comparing subjects who received ATG/GCSF versus placebo (p = 0.41). A modeling framework based on mean trajectories in C-peptide AUC over five years, accounting for differing trends between groups, was applied to re-categorize responders (n=9) and non-responders (n=7). ATG/GCSF reponders demonstrated nearly unchanged HbA1c over five years [mean (95% CI) adjusted change = 0.29% (-0.69%, 1.27%)], but the study was not powered for comparisons against non-responders 1.75% (-0.57%, 4.06%) and placebo 1.44% (0.21%, 2.66%). These data underscore the importance of long-term follow up in previous and ongoing phase 2 trials of low-dose ATG in recent-onset type 1 diabetes.

scholarly journals Low-dose ATG/GCSF in Established Type 1 Diabetes: A Five-Year Follow-up Report

2021 ◽  
Author(s):  
Andrea Lin ◽  
Jasmine A. Mack ◽  
Brittany Bruggeman ◽  
Laura M. Jacobsen ◽  
Amanda L. Posgai ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Low Dose ◽  
Area Under The Curve ◽  
Tolerance Test ◽  
Modeling Framework ◽  
C Peptide ◽  
Recent Onset

Previously, we demonstrated low-dose anti-thymocyte globulin (ATG) and granulocyte colony stimulating factor (GCSF) immunotherapy preserved C-peptide for two years in a pilot study of subjects with established type 1 diabetes (n=25). Herein, we evaluated the long-term outcomes of ATG/GCSF in study participants with five years of available follow-up data (n=15). The primary endpoint was area under the curve (AUC) C-peptide during a two-hour mixed-meal tolerance test (MMTT). After five years, there were no statistically significant differences in AUC C-peptide when comparing subjects who received ATG/GCSF versus placebo (p = 0.41). A modeling framework based on mean trajectories in C-peptide AUC over five years, accounting for differing trends between groups, was applied to re-categorize responders (n=9) and non-responders (n=7). ATG/GCSF reponders demonstrated nearly unchanged HbA1c over five years [mean (95% CI) adjusted change = 0.29% (-0.69%, 1.27%)], but the study was not powered for comparisons against non-responders 1.75% (-0.57%, 4.06%) and placebo 1.44% (0.21%, 2.66%). These data underscore the importance of long-term follow up in previous and ongoing phase 2 trials of low-dose ATG in recent-onset type 1 diabetes.

scholarly journals TYK2 Promoter Variant Is Associated with Impaired Insulin Secretion and Lower Insulin Resistance in Japanese Type 2 Diabetes Patients

Genes ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 400
Author(s):  
Hitoe Mori ◽  
Hirokazu Takahashi ◽  
Keiichiro Mine ◽  
Ken Higashimoto ◽  
Kanako Inoue ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Fasting Insulin ◽  
C Peptide ◽  
Impaired Insulin ◽  
Diabetes Patients

Accumulating evidence has suggested that viral infection causes type 1 diabetes due to direct β-cell damage and the triggering of autoimmune reactivity to β cells. Here, we elucidated that the tyrosine kinase 2 (Tyk2) gene, encoding an interferon receptor signaling molecule, is responsible for virus-induced diabetes in mice, and its promoter variant confers a risk of type 1 diabetes in humans. This study investigated the relationship between a TYK2 promoter variant (TYK2PV) and insulin secretion in type 2 diabetes patients. TYK2PV status was determined using direct DNA sequencing and its associations with fasting insulin, C-peptide, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated in type 2 diabetes patients without sulfonylurea or insulin medication. Of the 172 patients assessed, 18 (10.5%) showed TYK2PV-positivity. Their body mass index (BMI) was significantly lower than in those without the variant (23.4 vs. 25.4 kg/m2, p = 0.025). Fasting insulin (3.9 vs. 6.2 μIU/mL, p = 0.007), C-peptide (1.37 vs. 1.76 ng/mL, p = 0.008), and HOMA-IR (1.39 vs. 2.05, p = 0.006) were lower in those with than in those without the variant. Multivariable analysis identified that TYK2PV was associated with fasting insulin ≤ 5 μIU/mL (odds ratio (OR) 3.63, p = 0.025) and C-peptide ≤ 1.0 ng/mL (OR 3.61, p = 0.028), and also lower insulin resistance (HOMA-IR ≤ 2.5; OR 8.60, p = 0.042). TYK2PV is associated with impaired insulin secretion and low insulin resistance in type 2 diabetes. Type 2 diabetes patients with TYK2PV should be carefully followed in order to receive the appropriate treatment including insulin injections.

scholarly journals Алгоритм доклинической диагностики сахарного диабета 1-го типа как основа для создания Реестра ДААт-позитивных детей и подростков Украины с прогнозированным развитием заболевания

2019 ◽  
Vol 24 (3) ◽  
pp. 203-216
Author(s):  
M.D. Tron’ko ◽  
K.P. Zak ◽  
V.V. Popova
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Pancreatic Beta Cells ◽  
State Institution ◽  
Tolerance Test ◽  
The State ◽  
Immunological Study ◽  
C Peptide ◽  
Study Results

Aim — The establishment of mechanisms for T1D development at early and late preclinical stages of disease formation in children and adolescents. Material and methods. At the State Institution «V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine» mentioned the Program «Immunity in the preclinical period of T1D development» was initiated, on the basis of which the Register of marker-positive children with predictable development of type 1 diabetes was created, which includes 612 children aged from 7 to 15 years with burdened heredity, in which the titer of diabetes-associated autobodies (DAA), cytokines, levels of basal and postprandial glycemia and secretion of C-peptide at preclinical and clinical stages of T1D development in children and adolescents based on the performed clinical and immunological study. Results. The new data have been obtained at the State Institution «V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine», which allowed to substantially supplement the existing ideas about the type 1 diabetes (T1D) pathogenesis. As a result of the performed study, a group of marker-positive children with burdened heredity and a predicted risk of developing the disease was formed. It was found that an increased titer of DAA was observed in 162 (35.45%) of 457 children with burdened heredity with no less than two times determination of DAA presence in them, mainly GADA and IA‑2A, the clinical debut was manifested in 86 (53.08%) of them from 6 months to 16 years (27.4±4.3 months). The formula of combined occurrence and values of simultaneously increased DAA titers to islet autoantigens, namely IA‑2A + GADA, was determined, which is a predictor of both the duration of preclinical stage of T1D development and the debut rate. Impaired cytokine production (increase of the level of proinflammatory cytokines IL‑1α, IL‑6 and TNFα, IL‑8 and IL‑16 while reducing the concentration of IL‑4 in the PB) as key factors of the T1D pathogenesis, which determine the rate of T1D debut, and the aggressiveness of its course were also established. It was found that the early preclinical period of T1D development in DAA+ children was characterized by the presence of dysglycemia in the form of increased glycemia in 2 hour after the glucose tolerance test and a slight decrease in secretion of stimulated C-peptide; in addition, dysglycemia in the form of impaired fasting glycemia was added in DAA+children in the late preclinical period, and a decrease in both basal and stimulated secretion of the C-peptide was determined, indicating that the potential of pancreatic beta cells was depleted.

scholarly journals The Effect of Ethnicity in the Rate of Beta-Cell Functional Loss in the First 3 Years After Type 1 Diabetes Diagnosis

2020 ◽  
Vol 105 (12) ◽  
pp. e4393-e4406 ◽  
Author(s):  
Mustafa Tosur ◽  
Mario A Cleves ◽  
Jay M Sosenko ◽  
Ingrid Libman ◽  
David A Baidal ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Beta Cell ◽  
Clinical Diagnosis ◽  
Area Under The Curve ◽  
Diabetes Diagnosis ◽  
Z Score ◽  
C Peptide ◽  
Functional Loss ◽  
Intervention Trials

Abstract Objective We set forth to compare ethnicities for metabolic and immunological characteristics at the clinical diagnosis of type 1 diabetes (T1D) and assess the effect of ethnicity on beta-cell functional loss within 3 years after clinical diagnosis. Research Methods and Design We studied participants in TrialNet New Onset Intervention Trials (n = 624, median age = 14.4 years, 58% male, 8.7% Hispanic) and followed them prospectively for 3 years. Mixed meal tolerance tests (MMTT) were performed within 6 months following clinical diagnosis and repeated semiannually. Unless otherwise indicated, analyses were adjusted for age, sex, BMI Z-score, and diabetes duration. Results At T1D clinical diagnosis, Hispanics, compared with non-Hispanic whites (NHW), had a higher frequency of diabetic ketoacidosis (DKA) (44.7% vs 25.3%, OR = 2.36, P = 0.01), lower fasting glucose (97 vs 109 mg/dL, P = 0.02) and higher fasting C-peptide (1.23 vs 0.94 ng/mL, P = 0.02) on the first MMTT, and higher frequency of ZnT8 autoantibody positivity (n = 201, 94.1% vs 64%, OR = 7.98, P = 0.05). After exclusion of participants in experimental arms of positive clinical trials, C-peptide area under the curve (AUC) trajectories during the first 3 years after clinical diagnosis were not significantly different between Hispanics and NHW after adjusting for age, sex, BMI-z score, and DKA (n = 413, P = 0.14). Conclusion Despite differences in the metabolic and immunological characteristics at clinical diagnosis of T1D between Hispanics and NHW, C-peptide trajectories did not differ significantly in the first 3 years following clinical diagnosis after adjustment for body mass index and other confounders. These findings may inform the design of observational studies and intervention trials in T1D.

scholarly journals Insulin-Like Growth Factor-1 at Diagnosis and during Subsequent Years in Adolescents with Type 1 Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Simona I. Chisalita ◽  
J. Ludvigsson
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Insulin Treatment ◽  
Insulin Dose ◽  
Newly Diagnosed ◽  
Blood Samples ◽  
C Peptide ◽  
Endogenous Insulin ◽  
High Hba1c

Background. Type 1 diabetes (T1D) in adolescents is associated with alterations in the insulin-like factor system probably caused both by a deranged metabolism and insulinopenia in the portal vein. Objective. To study how the circulating IGF-1 is affected at diagnosis and during subsequent years in adolescents with T1D. Methods. Ten girls and ten boys with type 1 diabetes (T1D), aged 13.0 ± 1.4 (mean ± SD) years at diagnosis, took part in the study. Blood samples were drawn at diagnosis and after 3, 9, 18, and 48 months. HbA1c, total IGF-1, and C-peptide were measured. Results. At diagnosis, the patients had high HbA1c, low IGF-1, and measurable C-peptide. After the start of insulin treatment, maximal improvement in glycemic control and IGF-1 occurred within 3 months and then both tended to deteriorate, that is, HbA1c to increase and IGF-1 to decrease. C-peptide decreased with time, and after 4 years, half of the patients were C-peptide negative. At diagnosis, C-peptide correlated positively to IGF-1 (r=0.50; p<0.03). C-peptide correlated negatively with insulin dose (U/kg) after 18 and 48 months from diagnosis (r=−0.48; p<0.03 and r=−0.72; p<0.001, resp.). Conclusions. In conclusion, our results show that in newly diagnosed adolescents with type 1 diabetes and deranged metabolism, the IGF-1 level is low and rapidly improves with insulin treatment but later tends to decrease concomitantly with declining endogenous insulin secretion.

scholarly journals Type 1 diabetes can present before the age of 6 months and is characterised by autoimmunity and rapid loss of beta cells

Diabetologia ◽  
2020 ◽  
Vol 63 (12) ◽  
pp. 2605-2615 ◽  
Author(s):  
Matthew B. Johnson ◽  
◽  
Kashyap A. Patel ◽  
Elisa De Franco ◽  
William Hagopian ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Secretion ◽  
Genetic Risk ◽  
Early Onset ◽  
Genetic Risk Score ◽  
Neonatal Diabetes ◽  
Pathogenic Variant ◽  
Rapid Loss ◽  
C Peptide

Abstract Aims/hypothesis Diabetes diagnosed at <6 months of age is usually monogenic. However, 10–15% of affected infants do not have a pathogenic variant in one of the 26 known neonatal diabetes genes. We characterised infants diagnosed at <6 months of age without a pathogenic variant to assess whether polygenic type 1 diabetes could arise at early ages. Methods We studied 166 infants diagnosed with type 1 diabetes at <6 months of age in whom pathogenic variants in all 26 known genes had been excluded and compared them with infants with monogenic neonatal diabetes (n = 164) or children with type 1 diabetes diagnosed at 6–24 months of age (n = 152). We assessed the type 1 diabetes genetic risk score (T1D-GRS), islet autoantibodies, C-peptide and clinical features. Results We found an excess of infants with high T1D-GRS: 38% (63/166) had a T1D-GRS >95th centile of healthy individuals, whereas 5% (8/166) would be expected if all were monogenic (p < 0.0001). Individuals with a high T1D-GRS had a similar rate of autoantibody positivity to that seen in individuals with type 1 diabetes diagnosed at 6–24 months of age (41% vs 58%, p = 0.2), and had markedly reduced C-peptide levels (median <3 pmol/l within 1 year of diagnosis), reflecting rapid loss of insulin secretion. These individuals also had reduced birthweights (median z score −0.89), which were lowest in those diagnosed with type 1 diabetes at <3 months of age (median z score −1.98). Conclusions/interpretation We provide strong evidence that type 1 diabetes can present before the age of 6 months based on individuals with this extremely early-onset diabetes subtype having the classic features of childhood type 1 diabetes: high genetic risk, autoimmunity and rapid beta cell loss. The early-onset association with reduced birthweight raises the possibility that for some individuals there was reduced insulin secretion in utero. Comprehensive genetic testing for all neonatal diabetes genes remains essential for all individuals diagnosed with diabetes at <6 months of age.

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