Desang diabetes magazine diabetes news

NEWS

A team of physicians from Baylor College

of Medicine, Texas Children's Hospital and

the University of California, San Francisco,

have announced the first case of a patient

with Type 1 diabetes who no longer needs

insulin to maintain optimal blood sugar

levels. The physicians specifically targeted

the underlying genetic mutation, which

was the primary driver of this patient's

diabetes, using a precision medicine

approach.

The patient, a 17-year-old male, was

diagnosed with classical autoimmune

presentation of Type 1 diabetes (T1D). The

patient had also had recurrent episodes

of respiratory infections. This combination

led to his referral to Forbes' team.

"To the best of our knowledge, this is

the first example of a T1D patient who has

experienced a complete reversal of insulin

dependence. We are excited by the

prospect that this approach could be a

The Isle of Man's health service will

provide sensor systems to adults and

children with Type 1 diabetes. Freestyle

Libre sensors will be available for adults

who meet specific medical criteria based

upon NHS England recommendations,

identified by the specialist diabetes team

at Noble's Hospital. Freestyle Libre and

NEWS

REPORT

viable therapeutic strategy for a subset of

T1D patients," said corresponding author

Dr Lisa R. Forbes, deputy director for

clinical services and community outreach

for the Texas Children's William T Shearer

Center for Human Immunobiology

and assistant professor of paediatrics,

immunology, allergy and retrovirology at

Baylor.

A deeper investigation into the

patient's genome revealed that he

harboured a harmful mutation in the

gene STAT1 (signal transducer and

activator of transcription 1). The mutation

boosted the activity of the STAT1 protein.

Enhanced STAT1 protein activity is known

to drive respiratory infections and various

autoimmune conditions, including T1D.

The patient was treated with a

regimen of ruxolitinib, a potent inhibitor of

the Jak/STAT signalling pathway, which

had been shown previously to improve

many symptoms related to enhanced

JAK/STAT signalling.

For almost two years now, the patient

has not needed insulin. "This case was

quite fascinating!" said one of the lead

authors, Dr Sophia Ebenezer, assistant

professor of paediatric endocrinology at

Baylor and Texas Children's. "The patient

no longer needs daily insulin injections

and has shown full remission of other

clinical signs of T1D along with marked

improvements in his quality of life."

While these results are promising,

it remains plausible that this could be a

transient effect and could recur at a later

stage, the authors say. A longer clinical

assessment of the patient is required

to confirm if he can remain insulin-free

permanently.

Read the case report in the New

England Journal of Medicine and more

from the Texas Children's Hospital HERE.

T1D REVERSED - A FIRST

Dexcom G6 will be available for children

with Type 1 diabetes until they transition

to adult services, where they may be

offered the Freestyle Libre sensors and

monitors, subject to meeting the clinical

criteria set by NHS England. The sensor

systems will become available in the Isle

of Man through the NHS from November

ISLE OF MAN GETS SENSORS

via a staged implementation programme.

Patients and parents will need to

undertake online or face-to-face training to

ensure they understand fully how to utilise

the systems, and to ensure compliance.

Patient's eligibility and use of the system

will be monitored and reviewed every six

months in line with NHS guidance.

Dr Emma Wilmot, Prof Pratik Choudhary,

Dr Alistair Lumb on behalf of DTN-UK has

endorsed the International Consensus

on time in range (TIR). Last year, Tadej

Battelino and colleagues published the

International Consensus on time in range.

These international guidelines, combined

with the recent increase in patient access

to interstitial glucose monitoring, present

an opportunity to fundamentally change

and improve our approach to glucose

data in diabetes clinic consultations.

With the wealth of glucose

data available additional metrics of

therapeutic success, beyond HbA1c,

are now possible. The time in range

recommendations are new to many. It is

important that health care professionals

DTN UK ENDORSES INTERNATIONAL TIR CONSENSUS

become familiar with the specific guidance

for people with T1/T2 diabetes, those in

the high-risk category and women with

Type 1 diabetes who are pregnant. As

such, the Diabetes Technology Network

(DTN) UK has published, "Time in range:

a best practice guide for UK diabetes

healthcare professionals in the context of

the COVID-19 global pandemic."

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