A new study, published in the journal Science Advances and co-funded by Breakthrough T1D, uses cutting-edge technology to unravel how T1D develops in young children, paving the way for new strategies to prevent or delay T1D and, in time, contribute to a cure.
T1D progresses more quickly in younger children
In young children under the age of 7, T1D often progresses more rapidly than it does in older children and adults. This increases the likelihood of young children with T1D experiencing medical emergencies and requiring more insulin than people diagnosed at an older age.
Scientists have now made a major breakthrough in understanding why T1D is more aggressive in young children, offering the clearest explanation to date of why the condition is particularly difficult to manage when diagnosed early in life.
The biology of the pancreas
Until now, scientists had limited tools to study the early development of insulin-producing cells, called beta cells. Beta cells are found alongside cells that make other hormones in clusters called islets within the pancreas. In young children, these islets are small and still forming, so they only contain a few beta cells.
Understanding how T1D develops in young children
The new study, led by Professor Sarah Richardson at the University of Exeter in the UK, used highly advanced scientific techniques to study these small islets in unprecedented detail. The team analysed rare pancreas samples from more than 250 people of varying ages, both with and without T1D. They looked at how islets change as we age and how they are affected by the immune system.
The findings confirm that in early childhood, people without T1D have many small clusters of beta cells, which normally increase in size and mature with age, with the most rapid development occurring in the first few years of life.
Total destruction of insulin-making beta cells
For the first time, the researchers showed that in people with T1D, these small clusters are almost completely absent, having been destroyed by the immune system. While some people with T1D retained a few large clusters, allowing them to produce small amounts of insulin, this was not the case for those diagnosed at a young age.
Together, the results suggest that the abundant small clusters found in young children are especially vulnerable to the immune attack in T1D. Their rapid destruction prevents them from maturing, leaving very few beta cells later in life. This explains why children diagnosed with T1D at a young age are typically unable to produce any of their own insulin, making the condition particularly difficult to manage.
Professor Sarah Richardson said:
These tiny insulin-producing beta cell clusters – once overlooked – hold big clues to understanding type 1 diabetes. This new perspective has the potential to reshape how we screen, treat, and even prevent type 1 diabetes. Protecting small beta cell clusters early could be key to stopping type 1 diabetes before it starts.
Important insight for T1D treatment
This research underscores the critical role of these tiny islets in healthy pancreas development and opens the door for new treatments to protect them in children, giving them the chance to mature into larger islets that are less vulnerable to the immune attack.
It also strengthens the case for early T1D screening – particularly in young children – which is essential for identifying those in the early stages of T1D before these crucial cells are lost. In Australia, children with family members who have T1D can be screened through the Breakthrough T1D-funded project Type 1 Screen.
Dr Dorota Pawlak, Chief Scientific Officer at Breakthrough T1D Australia, said:
This sophisticated study sheds much needed light on why T1D progresses so much faster and is tougher to manage in young children. These important new insights help focus researchers’ attention on developing more efficient, personalised treatments for young people living with T1D. But we cannot protect what has already been lost, so this breakthrough cements the need for early detection and intervention of T1D through screening programmes like Type 1 Screen.
