Beyond Insulin

Insulin was first discovered 100 years ago, and 2022 marks its 100th year treating people with type 1 diabetes. But we may be on the cusp of a new treatment that could significantly reduce the need for insulin in newly-diagnosed patients.

January 2022 marks a century since insulin was first used to treat Leonard Thompson, a 14-year-old dying of type 1 diabetes. The then experimental treatment saved Leonard’s life.

Leonard needed insulin because his body’s immune system had targeted and destroyed the insulin-producing cells in his pancreas, meaning his blood sugar levels were not able to be controlled.

“Type 1 diabetes is still treated today by replacing insulin. To stay alive, people with diabetes are dependent on insulin replacement – given by multiple daily injections or an insulin pump – along with frequent blood glucose measurements,” explains Professor Tom Kay, Director, St Vincent’s Institute of Medical Research (SVI) and an internationally-renowned diabetes researcher.

But while lifesaving, insulin treatment has limitations.

A new approach

“The long-term complications of type 1 diabetes include heart attack, stroke, vision impairment, kidney disease and nerve damage – it is a significant condition,” says Tom. “Our century-old approach to managing this disease does not address its underlying cause: the processes which lead the body’s immune cells to destroy insulin-producing beta cells.”

A clinical trial being led by SVI aims to change that.

Dubbed “BANDIT” (BAricitinib in New onset type 1 DiabeTes), the trial is investigating whether baricitinib – a drug used to treat rheumatoid arthritis – can protect insulin-producing beta cells from immune attack.

“Our aim is to retain those beta cells still present when type 1 diabetes is first diagnosed, and prolong the body’s own production of insulin,” says Professor Helen Thomas, BANDIT co-investigator and Head of the Immunology & Diabetes Unit.

“If this trial proves successful, people with type 1 diabetes could be significantly less dependent on insulin treatment. That would herald a massive change in type 1 diabetes care.”

BANDIT trial explainer:

(article continues below video)

The researchers

Some of the nation’s top type 1 diabetes clinical researchers are collaborating on the BANDIT trial with SVI. They include Associate Professor John Wentworth at The Royal Melbourne Hospital; Professor Fergus Cameron, Director of the Department of Endocrinology and Diabetes at The Royal Children’s Hospital Melbourne; Professor Richard MacIsaac, Director of Endocrinology and Diabetes at St Vincent’s Health and Professor Jennifer Couper, who heads the Diabetes and Endocrinology Department at the Women’s and Children’s Hospital, Adelaide.

“We’re optimistic that with the support of our generous trial participants and the expertise of these outstanding clinicians, we will see positive results,” says Helen. “We are very hopeful of being able to change the lives of people diagnosed with type 1 diabetes in future.”

“That would be a dream come true for us, and for those patients.”

Recruitment for this clinical trial has now closed. However, more information is available at www.svi.edu.au/bandit

Anders puts his hand up for type 1 diabetes

“Will I still be able to surf big waves?”

That was Anders’ first thought when he was diagnosed with type 1 diabetes at the age of 29.

Anders was concerned he may not be able to surf anymore

“I’d lost about 10 kilos in six weeks. My gut feel was there was bound to be a simple explanation and I wasn’t that concerned, but my girlfriend encouraged me to go see a doctor.”

“I had other symptoms, in hindsight. My mouth was very dry, and I was drinking lots of water, but it didn’t occur to me to mention this to the doctor.”

Helping other patients was a key motivator

Anders was the second person to be enrolled in SVI’s BANDIT clinical trial. The drug baricitinib is approved globally for rheumatoid arthritis patients, but SVI researchers have discovered that it may also stop the immune system from attacking insulin-producing cells in the pancreas.

Friends and family had told Anders about the trial after hearing about it in the media. Anders said he immediately considered enrolling, for a few reasons.

“The more altruistic reason was that I could play a role in research that could potentially help people diagnosed with type 1 diabetes in future. Having just been diagnosed, I understood how very tough it could be.”

“Secondly, I really hope this works and makes the rest of my life easier to manage. I realise there’s a chance that I may be one of those participants who is getting the placebo drug, but at the end of the day.”

“I’m getting great care, and contributing to what I think is an important research project.”

Riding the wave

Like his type 1 diabetes diagnosis, taking part in a clinical trial raised many questions.

“The endocrinologist who is leading the trial at the hospital was very reassuring. He walked me through the questions I had about the information and put it into more familiar terms for me.”

While he is hoping his participation in the trial may see his glucose levels stabilise, Anders is happy to report that he has indeed managed to find a way to keep enjoying surfing big waves.  “That’s been a really positive revelation,” he notes.

Anders is now learning to ‘ride the wave’ of his type 1 diabetes diagnoses, and he still holds hope that new treatments for people with the disease will be found.

“You just never know when a trial like the BANDIT is going to lead to a huge breakthrough in science, so I would encourage everyone to take part in a clinical trial if they are given the chance.”

Podcast:

The Herald Sun’s podcast ‘The Splash’ with Grant McArthur provided a great explanation of the trial (starting at 40 seconds):

Listen on Apple Podcasts.

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