Leading researcher on Type 1 diabetes discusses new advances in addressing the disease

Alberta Diabetes Institute director Peter Senior.

Under Peter Senior's leadership, the Alberta Diabetes Institute, recognized as Canada's most prominent centre dedicated exclusively to diabetes research, is at the forefront of the global battle against the disease, with a particular focus on finding innovative ways to tackle the high incidence of Type 1 diabetes in Canada.

Senior, a specialist in endocrinology, notes that the routine of daily insulin injections, which has remained largely unchanged since its introduction, continues to be the standard treatment for most individuals managing Type 1 diabetes. 

Recently, he’s been studying the autoimmune aspect of Type 1 diabetes, a process wherein the body's defence mechanism mistakenly targets and destroys insulin-producing beta cells. He notes that, unlike other autoimmune diseases such as psoriasis and rheumatoid arthritis — which have witnessed revolutionary therapeutic advances, including biologics — the quest for a groundbreaking diabetes treatment continues.

“Numerous trials have demonstrated potential in slowing the destruction of beta cells and lessening insulin needs in patients newly diagnosed with the disease,” Senior explains.

Early treatment, ideally at diagnosis, is key, he adds. “The disease [can progress gradually] before symptoms manifest, making early detection and intervention imperative, and Type 1 diabetes in adults can often be misdiagnosed initially because onset is slow in this demographic, contrary to common beliefs that Type 1 diabetes is a pediatric disease with a rapid onset.”

When patients are newly diagnosed, the most common information they receive is that insulin is the only treatment option. “Clinical trials offering alternative treatments are not always available or known to patients at the time of diagnosis,” says Senior.

The promise of teplizumab

In a landmark clinical trial, conducted in the US reached a significant milestone was reached in the quest to delay the onset of Type 1 diabetes. “The trial revealed that intervention using the drug teplizumab could defer the manifestation of diabetes by up to three years, a finding that signifies a potential 50 per cent reduction in disease progression over that period,” says Senior. 

Teplizumab has been approved in the U.S. for delaying the onset of Type 1 diabetes and is also showing promise in newly diagnosed patients. It is administered by intravenous infusion once daily for 14 consecutive days, and in most patients has only mild side-effects, akin to flu-like symptoms. 

This trial’s implications for diabetes prevention are monumental, particularly for the 10 per cent of cases that are more predictable due to their familial link. 

The sobering reality is that many people are unaware of the risk factors associated with Type 1 diabetes until the disease manifests. To bridge the gaps in awareness and prevention, Senior is part of a national consortium (CanScreenT1D) backed by a $12-million grant aimed at developing screening programs for Type 1 diabetes risk. The objective is to identify those at high risk before the disease develops, offering them the chance to delay its onset with treatments such as the drug teplizumab.

“This drug is priced at a steep $200,000 to $250,000 for the course of treatment and is not yet available in Canada, but its efficacy presents a great deal of hope,” Senior says. It raises a pivotal question: If the drug is licensed for delaying diabetes, could it not be used for those newly diagnosed?

The ADI was one of three Canadian centres participating in another trial of teplizumab which suggests this may be the case. The trial showed teplizumab could preserve insulin-producing beta cell in newly diagnosed adolescents with Type 1 diabetes. “The fact that the trial was conducted in adolescents speaks to an acceptable risk profile of the drug”.

Navigating the path from clinical trials to new treatments being available in the clinic is complex. Senior and fellow ADI researcher, Anna Lam, are part of an international consortium hosted by the Critical Path Institute , supported by organizations such as Juvenile Diabetes Research Foundation (JDRF) and industry partners, is striving to build comprehensive datasets that demonstrate the tangible benefits of interventions like teplizumab to regulatory bodies such as the FDA.

The research journey to new treatments for Type 1 diabetes

Senior's journey into the field of diabetes treatment began with the islet transplant program at the U of A. What was intended to be a year of learning extended indefinitely as he became integral to the program's progress. In islet transplantation, individuals with no beta cell function receive transplants, allowing them to produce insulin again and potentially live injection-free. However, the risk of immune system rejection or wear-out over time led to a need for tools to monitor beta cell function reliably.

Senior and his team developed a simple, yet innovative, composite score, which effectively predicts the long-term viability of transplanted islets. “This score, calculated using a single blood test, has become a cornerstone in evaluating islet transplant success. It also sparked the idea that this score could be useful in other areas of diabetes treatment, particularly in monitoring the effectiveness of new drugs in clinical trials for Type 1 diabetes,” Senior adds.

“Teplizumab, a drug initially developed for islet transplantation to prevent immune rejection can also eliminate autoreactive lymphocytes — the cells that mistakenly attack one's own tissues in autoimmune diseases like Type 1 diabetes,” says Senior. The hope is that by deleting these cells, new lymphocytes will be trained to recognize the body's tissues as its own, preventing further autoimmune attack.

Preventing Type 1 diabetes before it starts

“The revelation that some high-risk individuals in clinical trials [for teplizumab] did not develop Type 1 diabetes even after six years shows the promise of these therapies,” says Senior. However, he stresses that effective prevention depends on awareness and the ability to screen people before they develop the disease. 

Senior envisions the next decade as "hugely exciting," with advancements in prevention, monitoring and treatments. 

The commitment to this cause is not just about developing new treatments, but also about ensuring that they are available, affordable, and part of a holistic approach to diabetes care that includes education, screening and ongoing support.