Megan and Madeline Coder are twins who do everything together — like ballet and even raising sheep in their hometown, Battle Ground, Washington. But in the fall of 2014, when Megan was nine, she learned she had something that Madeline didn’t: type 1 diabetes (T1D).
“My mom has T1D and my sister died from T1D complications in her early 30s,” says Keri Coder, Megan and Madeline’s mom. “The T1D tools have gotten a lot better, but it was still scary when Megan was diagnosed — I couldn’t stop checking on her at night.”
Megan’s doctors recommended that her brothers and sisters get tested to see if they might develop the disease. Of the nine siblings, only Madeline had biomarkers that showed she would almost certainly get T1D. Fortunately, the Coders also learned that Madeline could join a clinical study — led by TrialNet and involving Benaroya Research Institute at Virginia Mason (BRI) — of a drug called teplizumab that could potentially slow T1D down.
This study made a breakthrough earlier this year, when BRI and Type 1 Diabetes TrialNet — a global clinical research network chaired by BRI’s Carla Greenbaum, MD — showed that teplizumab delayed T1D for a median of two years for those at high risk for the disease. The results were announced at the American Diabetes Association 79th Scientific Sessions on June 9 and concurrently published in the New England Journal of Medicine.
“We’ve believed that delaying T1D was possible for decades, and we finally found a way to do it,” Dr. Greenbaum says. “It’s a step toward delaying T1D for longer, and hopefully preventing it altogether.”
Slowing Immune Attacks
The teplizumab study is part of BRI’s decades-long push to predict, prevent and cure T1D. One milestone came years ago, when TrialNet identified biomarkers that show a person will likely get T1D, making it possible to predict the disease before symptoms occur. The next step was finding ways to slow it down.
Teplizumab intrigued Dr. Greenbaum’s team after studies showed it could hinder cells that attack the pancreas in T1D. The researchers wondered: Could it also thwart attacker cells in people who don’t have the disease yet?
Researchers recruited 76 people who were on track to develop T1D, including Madeline. She and her mom spent two weeks in Seattle, where Madeline received an infusion of teplizumab every morning. Then the pair spent the afternoons exploring the city.
As researchers monitored the participants, they found that those who received teplizumab were diagnosed with T1D a median of two years later than participants who received a placebo.
“It’s great that this drug can delay diabetes, and it also shows that we can treat people before they get the disease,” says BRI President Jane Buckner, MD. “This helps us make the argument for treating T1D earlier and opens the door to new trials that try to prevent it.”
The Next Frontier
Madeline was eventually diagnosed with T1D but, thanks to teplizumab, not until she was 12 — three years after her sister.
“It’s a gift to people like Madeline because they can spend less of their lives managing T1D,” Dr. Greenbaum says. “And it helps them stay healthier because we know that the longer the body produces its own insulin, the better.”
Madeline and Megan are high school freshmen now, and they work together to manage their T1D.
“We check on each other and help each other — and that helps us be more independent, together,” Madeline says.
Still, both girls are excited about research that could make life easier for people like them.
“It gives me hope that if I ever have kids and they get diabetes, there might be a cure,” Megan says.
For BRI researchers, the study proves they can slow down immune attacks that trigger T1D — which inspires them to apply these findings to other areas of research.
“This discovery pushes us to ask the same questions about other diseases: Can we predict who will get multiple sclerosis or RA? Could we prevent them altogether?” Dr. Buckner says. “We’re going to keep pushing to answer these questions, and we won’t stop until we make our vision of a world without autoimmune disease a reality.”
Dr. Greenbaum encourages those who have a relative with T1D to get screened and see if they’re eligible for clinical trials. Learn more at Trialnet.org or by emailing Diabetes@benaroyaresearch.org.
Originally published in BRING IT ON newsletter - Fall 2019
August 26, 2019
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