What is type 1 diabetes and how is it treated?
It is a chronic condition in which the pancreas produces little or no insulin, a hormone that regulates blood sugar levels. It typically appears in adolescence and requires lifelong management with insulin injections or pumps. Insulin therapy helps to control blood glucose levels and prevent serious complications, such as heart disease, kidney failure, nerve damage, and vision loss. However, it does not cure the disease or stop the immune system from attacking the insulin-producing cells in the pancreas.
How does baricitinib work and what are its benefits?
Baricitinib is a drug that is approved for the treatment of rheumatoid arthritis, an autoimmune disease that causes inflammation and pain in the joints. It belongs to a class of medications known as JAK inhibitors, which block the activity of enzymes involved in inflammation and immune responses. The researchers at St Vincent’s Institute of Medical Research (SVI) in Melbourne, Australia, hypothesized that baricitinib could protect the remaining insulin-producing cells in the pancreas from being destroyed by the immune system, which is the underlying cause of type 1 diabetes.
To test this idea, they conducted a randomized, double-blind, placebo-controlled trial involving 91 participants aged between 10 and 30 years who had been diagnosed with type 1 diabetes within 100 days. They assigned 60 participants to receive baricitinib and 31 to receive a placebo for one year, while continuing their usual insulin therapy. They measured their blood glucose levels and insulin production throughout the trial.
The results showed that baricitinib was safe and effective at slowing the progression of type 1 diabetes in people who had been recently diagnosed. The participants who received baricitinib had significantly higher levels of C-peptide, a marker of insulin production, than those who received placebo at the end of the trial. They also required less insulin for treatment and had lower blood glucose variability.
The researchers concluded that baricitinib could be the first disease-modifying treatment of its kind for type 1 diabetes that can be delivered as a tablet. They said that it could improve the quality of life and long-term outcomes for people with type 1 diabetes by preserving their own insulin production and reducing the risk of complications.
What are the next steps and challenges?
“It is tremendously exciting for us to be the first group anywhere in the world to test the efficacy of baricitinib as a potential type 1 diabetes treatment,” said Professor Thomas Kay, the clinical lead on the trial. “Up until now, people with type 1 diabetes have been reliant on insulin delivered via injection or infusion pump. Our trial showed that, if started early enough after diagnosis, and while the participants remained on the medication, their production of insulin was maintained.”
The study was funded by JDRF Australia and Eli Lilly and Company, the manufacturer of baricitinib. The researchers said that they are planning to conduct further trials to confirm the long-term benefits and safety of baricitinib for type 1 diabetes.
However, they also acknowledged some limitations and challenges of their study. For instance, they noted that baricitinib may have some side effects, such as increased risk of infections or blood clots. They also said that baricitinib may not work for everyone with type 1 diabetes or for those who have had the disease for a long time. They suggested that more research is needed to identify which patients are most likely to benefit from baricitinib and how to optimize its dosage and duration.
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