A special joint symposium presented Monday, June 24, by the ADA’s journals—Diabetes^®, Diabetes Care^®, and Diabetologia^®—highlighted various aspects of type 1 diabetes heterogeneity and how increasing knowledge may lead to personalized or pathogenic-derived treatment.

ADA Diabetes Care/Diabetes/Diabetologia Symposium—The Heterogeneity of Type 1 Diabetes: Pathogenesis, Treatment, and Prevention can be viewed on-demand by registered meeting participants on the virtual meeting platform. If you haven’t registered for the 84^th Scientific Sessions, register today to access the valuable meeting content through Aug. 26.

Carmella Evans-Molina, MD, PhD, Indiana University School of Medicine, discussed the therapeutic challenges associated with heterogeneity in type 1 diabetes and how improving our understanding of various aspects of that heterogeneity might accelerate the development of new therapies.

“Heterogeneity has a really important role in helping us understand type 1 diabetes progression and in helping us inform clinical trial interventions,” Dr. Evans-Molina said. “The impacts of metabolic heterogeneity during disease progression, for example, have really important implications in our trial design, and there are likely baseline immune signatures that can help us identify people who are potentially prime to respond to disease-modifying therapy.”

While the approval of teplizumab as the first disease-modifying therapy for type 1 diabetes certainly represents a landmark achievement, Dr. Evans-Molina said the development of future therapies may benefit from emerging models of heterogeneity and take less time to achieve.

“One of the biggest challenges that we have to acknowledge is it took us 30 years to get to an approval of a disease-modifying therapy with this particular class of agents,” she said. “What we would like to have in type 1 diabetes are multiple therapies, so a big gap in the field and a goal we should all have is determining how we can design trials that take less time to complete, that enroll faster so we can have answers on whether they are able to delay disease progression.”

Jeffrey R. Millman, PhD, Washington University School of Medicine, discussed how aspects of heterogeneity might influence research and future applications of cellular therapy for type 1 diabetes.

“Cell therapy has proven to be an effective treatment for controlling blood sugar levels in patients with type 1 diabetes,” Dr. Millman said. “When it works, it works quite well, with patients enjoying good blood glucose control; however, there is a lot of heterogeneity embedded in the use of cell therapy.”

He said that the use of induced pluripotent stem (iPS) cells, for example, is not only useful for therapy but may also be useful in terms of addressing issues of patient heterogeneity.

“There is an idea in the field that is not feasible right now, but something that we’re striving toward, and that is to get a large number of iPS lines generated that represent the diversity and heterogeneity intrinsic in the type 1 diabetes population,” Dr. Millman said. “We can then make these into beta cells and study aspects of the genetics, environmental factors, and immune cell interactions that could give us new insights into why type 1 diabetes exists in the first place.”

Other speakers during the symposium included Richard David Leslie, MBBS, MRCS, MD, FRCP, FAoP, Blizard Institute, University of London, United Kingdom; Raghavendra G. Mirmira, MD, PhD, University of Chicago; and Maria Jose Redondo, MD, PhD, MPH, Baylor College of Medicine, Texas Children’s Hospital.

The panel participants will prepare a comprehensive review of the state-of-the-science on type 1 diabetes heterogeneity for future co-publication in the three journals.