Frank Martin, PhD, director of research at JDRF, on the organization’s T1Detect screening program and exploring potential causes of type 1 diabetes.
Genetics alone does not explain someone’s risk of developing type 1 diabetes, said Frank Martin, PhD, director of research at JDRF.
JDRF is actively encouraging people to take part in a screening initiative called T1Detect. Can you describe what T1Detect is and tell us who is eligible to participate?
T1Detect is really a 3-fold program around education, awareness, and screening for type 1 diabetes (T1D) risk in the general population. So the eligibility is really anyone. Up until now, the majority of programs that have looked for T1D risk, looked for that in people who already have T1D in their family. We and many investigators in the field saw a gap there, that we needed to be able to provide screening to people who are not related to T1D. It's almost 85% to 90% of people who are diagnosed don't have a family history of T1D. Programs like T1Detect will help that out.
Previous studies have found various reasons for increased rates of T1D in youth. Can you elaborate on these findings?
That is true. Unfortunately, there's been no single smoking bullet to explain the causes of T1D. We know from studies like TEDDY, SEARCH, ASK, Fr1da—these are studies here in the United States and across the world—that there's a high genetic contribution. However, genetics alone does not explain someone's risk of developing T1D. Programs like TEDDY and others have shown that there are some environmental factors that play a role, but no single one has shown priority. But things like viral infections have been shown to be linked to the onset of T1D. And as such, there are vaccine programs to try and address those viral infections and hopefully bring down the rates of T1D.
There's been some evidence that dietary changes might be linked to T1D risk. Programs in Europe have shown that there is a significant difference in the microbiome, the bacteria that lives in people's guts, from people who have high rates of T1D vs people who have low rates of T1D. That suggests that there's some bacteria or family bacteria living in our gut that might influence our propensity toward autoimmunity, toward your immune system attacking yourself. That doesn't encapsulate all the other potential causative factors out there—and we're still looking to try and find those causative factors—but I don't believe it's going to be one factor for everyone. It's likely going to be personal. Our focus right now is really on what can we do with people before they're diagnosed and do with people when they're diagnosed to really improve the way they live with T1D or delay their T1D experience through prevention studies.
The SEARCH study found that T1D rates were rising faster among minority youth than the general population. Your T1Detect website makes note of this—are there any special outreach efforts to ensure that minority populations get screened?
It was a very important, very striking finding from the SEARCH study that in the recent period analyzed—which went up to 2015—they're looking at the rates of T1D across the United States and across the world, really. We're sort of shocked to see that the groups with the highest increases in their rates of T1D were Hispanic youth and non-Hispanic minority youth, especially those between the ages of, I think, 18 to 25. This tells us one important thing about T1D: that genetics don't control all of T1D. Genetics in a population don't change that quickly, that all of a sudden Hispanic youth have genetics that make them at risk for T1D. It really points to an environmental factor that is creating an increased risk in these populations.
What JDRF and a lot of our partner organizations are focused on is how do we, one, increase the prognosis of T1D risk in these populations. Part of that is through research programs, like the ASK program in Colorado, for example, is specifically looking how to improve access to screening for non-White youth. This is taking advantage of telemedicine technologies, remote clinics, things like that. We're also trying to educate those specific communities about diabetes technology use, because things like pumps and monitors could really help their day-to-day T1D experience. That looks like education, that looks like specific targeted advertising campaigns, which are handled by my marketing and communications colleagues. Also partners of ours, like Beyond Type 1 Diabetes, are very useful in disseminating the important education to these communities. While we're disheartened to see that there is an increase in T1D diagnoses in these populations, we're coming up with strategies to better address and specifically address those, looking toward improving the health of those populations.