Immunology and Type 1 Diabetes

As an autoimmune disorder, the immune system causes Type 1 Diabetes (T1D) by mistakenly attacking insulin producing cells in the pancreas called beta cells. Insulin is a hormone that is critical for your body to convert sugar (glucose) from your blood into the energy your body needs. Overtime, as the immune system destroys beta cells in the pancreas your body will no longer be able to produce insulin.  

It is unknown what causes the immune system to attack beta cells, but both genetics and environmental exposure may play a role. As with any autoimmune disorder, the immune cells that accidentally attack our own cells are called “‘self-reactive” cells.  Generally, as the immune system makes new T and B cells, it tries to ensure that any cells that strongly react against your own cells and tissues are deleted before they can cause harm. While the immune system eliminates many self-reactive cells, it isn’t perfect, and some of these self-reactive cells slip through. In the case of T1D, once these self-reactive cells are released in the body, they attack your pancreas.  

There is no cure for T1D, but treatment is available to manage the level of sugar in your blood. Treatments for T1D generally include using synthetic insulin paired with diet and exercise to keep your blood sugar in a healthy range. This treatment addresses the impact of T1D, but does not prevent the immune system from destroying insulin producing cells.  

What’s Next for Type 1 Diabetes

Immunology research may hold the key to developing a cure for T1D or treatments that prevent the disease from worsening. In 2022, the Food and Drug Administration in the United States approved an immunotherapy for T1D called teplizumab (brand name Tzield™). When most people are diagnosed with T1D, they still have some insulin producing beta cells. Teplizumab modulates the immune system so that it is less likely to kill these remaining beta cells. For some people who are at a higher risk for T1D, teplizumab can delay the onset of T1D for years. This immunotherapy is the first treatment that address the autoimmunity of T1D and not just the symptoms of insulin loss. Decades of research spanning back to 1988 helped to develop this immunotherapy that allows people to live longer without the burden and complications of an autoimmune disorder. 

Immunologists are also researching how to cure T1D. mRNA vaccines that train the immune system to protect insulin producing cells rather than attack them could cure the disorder and prevent patients from needing insulin treatment. Immunologists are also researching how stem cells could be used to cure T1D. Stem cells are cells that can become any type of cell a patient might need. For patients with T1D, stem cells could be developed into insulin-producing beta cells that could replace the beta cells the patient lost and reverse the disease. 

As these new approaches evolve, the future of Type 1 Diabetes treatment is moving toward addressing the autoimmunity of the disease and not just the symptoms — leading to a world where disease onset is delayed or potentially prevented altogether.