Despite the potential relevance of early childhood metabolism on health, little is known about longitudinal glucose homeostasis in the first years of life and its potential relationship to type 1 diabetes (T1D) development. Now, scientists led by the Helmholtz Munich Institute of Diabetes Research report novel insights into the relationship between blood sugar regulation during early childhood and the development of autoimmunity.

The findings are published in the Journal of Clinical Investigation in a paper titled, “Elevations in blood glucose before and after the appearance of islet autoantibodies in children.”

“The etiology of type 1 diabetes has polygenic and environmental determinants that lead to autoimmune responses against pancreatic β cells and promote β cell death,” wrote the researchers. “The autoimmunity is considered silent without metabolic consequences until late preclinical stages, and it remains unknown how early in the disease process the pancreatic β cell is compromised. To address this, we investigated preprandial nonfasting and postprandial blood glucose concentrations and islet autoantibody development in 1,050 children with high genetic risk of type 1 diabetes.”

“Our results change our understanding of the development of type 1 diabetes. We show that metabolic changes occur in an earlier phase of the disease than previously anticipated,” explained Anette-Gabriele Ziegler, PhD, director at the Helmholtz Munich Institute of Diabetes Research (IDF). Together with an international team of researchers, she conducted the POInT study. The team examined the pre- and post-prandial blood sugar levels together with islet autoantibodies in the participating children.

“The dynamic changes in glucose metabolism in the first years of life were a surprise to us. They very likely reflect changes in the pancreatic islets and signal that we need to study glucose metabolism and the pancreas in early life more intensely,” said Katharina Warncke, PhD, chief physician for pediatric endocrinology/diabetology at the department of pediatrics, and a scientist at the IDF.

The scientists observed that in children who developed autoimmunity compared to children who did not, blood sugar levels after meals were already higher two months before the formation of islet antibodies.

“The change in post-meal blood sugar levels shortly before the initial detection of autoantibodies points to the likelihood that there is an event impairing the function of the islets preceding and contributing to the autoimmune reaction. As glucose values further increase after seroconversion, the impairment or damage seems to be sustained leading to further glucose instability,” explained Warncke.

“The observed changes in blood sugar levels in relation to autoantibody formation are exciting. Now we know that the start of the disease process is likely to be acting at the pancreatic islets and we can focus our research to find the cause of this chronic illness,” said Ezio Bonifacio, PhD, professor at the Center for Regenerative Therapies Dresden at the Technische Universität Dresden.

In summary, the scientists discovered that metabolic alterations occur in a much earlier stage of the disease than previously assumed. Their findings suggest that the excess increase in blood sugar levels after eating and shortly before the formation of antibodies is connected to a change in islet cell function.

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