Prior to the discovery of insulin, it was exceptional for people with type 1 diabetes to live more than a year or two. Since its discovery in 1921 at University of Toronto by Sir Frederick G Banting, Charles H Best and JJR Macleod – and subsequently purified by James B Collip – millions of lives have been saved. 

The Charles Perkins Centre Type 1 Diabetes Node brings together our internationally recognised experts with multidisciplinary expertise to design and implement creative solutions for people with type 1 diabetes. Our work spans the spectrum from improving current therapies, to finding a cure for those living with the condition, to preventing type 1 diabetes altogether.

Here we examine the ways in which the Charles Perkins Centre is investigating solutions through its numerous Type 1 Diabetes Node projects.

Finding a Cure

Cell-based therapies for curing type 1 diabetes

Lead Investigators | Professor Peter Thorn (Project Leader), Dr Melkam Kebede, Professor Marcela Bilek, Professor Tony Weiss, Associate Professor Steven Wise

The secretion of insulin from pancreatic β cells – beta cells, a type of cell found in pancreatic islets that synthesise and secrete insulin and amylin – is critical to maintaining blood glucose levels. Loss of function in β cells is causal in type 2 diabetes and immune destruction of β cells triggers type 1 diabetes.

Professor Thorn and his team are working in the Thorn Lab to understand β cell function in health and in disease. The team has discovered that β cells have an intimate relationship with blood vessels that is important for the control of insulin secretion. The identification of this mechanism will be important in understanding how type 2 diabetes develops and essential information for the development of cell-replacement therapies in the treatment of type 1 diabetes.

Preventing type 1 diabetes

National childhood screening for type 1 diabetes

Lead Investigators | Dr Kirstine Bell (Principal Research Fellow), Professor Maria Craig, Professor Natasha Nassar, Dr Antonia Shand, Professor Adrienne Gordon, Professor Kirsten Howard, Dr Sarah Norris

Three Australian children are diagnosed with type 1 diabetes every day in Australia and one of these three kids will be diagnosed too late – resulting in life-threatening diabetic ketoacidosis (DKA) that requires hospitalisation in intensive care. However, recognition of two early, pre-symptomatic stages allows for early identification and the potential to prevent, or at least delay, type 1 diabetes altogether.

Launching in early 2022, Dr Kirstine Bell – alongside the Charles Perkins Centre’s Professors Maria Craig, Natasha Nassar, Adrienne Gordon, Kirsten Howard and Drs Antonia Shand and Sarah Norris – is leading the first-ever Australian National Screening Program pilot for type 1 diabetes. Funded by JDRF Australia and JDRF International, their vision is to routinely screen all Australian children for type 1 diabetes, to identify children as early as possible, avoid a traumatic diagnosis experience, improve their longterm health and create the window of opportunity to prevent type 1 diabetes.

Preventing diabetes complications

Lead Investigator | Professor Alicia Jenkins

The (Fenofibrate and Microvascular Events) FAME 1 Eye Study is working to prevent vision loss in type 1 diabetes. Over time, elevated blood glucose levels can cause damage to the tiny blood vessels around the body, including in the eyes, leading to eye disease and blindness.  The FAME 1 Eye Study is investigating whether fenofibrate, a drug that is already on the market to lower cholesterol and blood fats, can slow or reverse eye damage and other complications in adults with type 1 diabetes. It is known that fenofibrate improves blood fats and slows the progression of eye damage in people with type 2 diabetes, so this study will see if it has the same effect in type 1 diabetes.  Despite the challenges posed by COVID, 22 clinical sites have recruited almost half of the 450 participants.

One of the study's research assistants, Sharon Atkinson-Briggs has had her PhD thesis passed recently. Sharon's work relates to a novel nurse-led model of diabetes care integrating eye screening and diabetes education in Indigenous-led primary care centres. Dr Nicola Quinn from Queens University, Belfast also completed a successful post-doctoral period evaluating novel methods to predict eye outcomes in people with diabetes, such as retinal vessel calibre and cornal nerve assessments.

Improving life with type 1 diabetes

New diabetes technologies

Lead Investigator | Professor Alicia Jenkins

As individuals with type 1 diabetes cannot produce their own insulin, injecting insulin to maintain blood glucose levels in the tight healthy range is essential for survival. This research project investigates diabetes technologies to understand and improve the way insulin is delivered to the body (through an insulin pump), new and improved ways of measuring blood glucose levels without finger pricks (using continuous glucose monitoring devices), and systems to automatically adjust insulin delivery based on blood glucose levels (closed-loop systems). 

The team has successfully completed closed-loop pump clinical trials in both adults and children, with positive clinical outcomes and four publications to date.  Dr Emma Scott received her PhD related to glucose variability in type 1 and type 2 diabetes and the effects of the different insulin delivery modalities. Additional grants are pending for further trials of adjunct therapy and new insulin pumps and sensors to improve glucose control and to retard kidney disease progression.

High intensity interval training in type 1 diabetes

Lead Investigators | Dr Angela Lee, Professor Stephen Twigg

While being physically active has many benefits, managing blood glucose levels and avoiding low blood glucose (hypoglycaemia) before, during and after exercise can be a major barrier to exercise for individuals with type 1 diabetes. This project addressed the health benefits of high intensity internal training (HIIT) for adults with type 1 diabetes who are overweight or obese. The study found that HIIT can lead to improved blood glucose levels in a safe manner in those who undertake it regularly. The novel research has been published in the peer reviewed international journal, Diabetes Care, and enabled endocrinologist Dr Lee to complete her PhD studies, receiving a major national Research Award in the process.

Supported by Diabetes Australia Research Program grant, and a NHMRC of Australia Postgraduate Scholarship and JDRF Australia Top-up Scholarship to Dr Angela Lee.  You can hear more about their research here.

Insulin dosing for fat and protein in type 1 diabetes

Lead Investigators | Dr Kirstine Bell, Professor Stephen Twigg, Professor Jennie Brand-Miller

Traditionally, only carbohydrate is ‘counted’ when estimating mealtime insulin doses in type 1 diabetes.  However, Charles Perkins Centre research has shown fat and protein also have significant impacts on blood glucose levels and therefore need to be included in insulin dosing. This research has changed clinical practice and underpinned new recommendations in international clinical guidelines, including the American Diabetes Association’s Standards of Medical Care.

This project recently completed a series of mealtime studies, including looking at the effects of varying the type of animal protein and the effect of varying the carbohydrate type (ie the glycemic index) on blood glucose levels.  The latter study was designed and conducted by Charles Perkins Centre Summer Research Scholarship recipient, Celia Li. Cindy had a review article published by the American Academy of Nutrition and Dietetics and submitted her original research for publication, both related to this project.

Hero image: 3D illustration of blood cells and glucose in a human vein