We are asking the government to renew crucial funds for T1D research

JDRF seeks $15M in funding for research

August 26, 2020

As 2021 draws near, we move closer to an important milestone that changed and aided the type 1 diabetes (T1D) community in an enormous way – the 100th year of insulin.

In the past, treatment for T1D meant restricting calories, carbs and certain foods altogether to nearly the point of starvation. Life for people with type 1 diabetes before insulin was short and dreadful – typically two years for adults and a year for children– ending in blindness, loss of limbs, kidney failure, heart attack or stroke. Banting House in London describes diabetes before insulin as a “death sentence.” The discovery of insulin in 1921 by Canadians Sir Frederick J. Banting and Dr. Charles Best made it possible to manage diabetes and is often described as Canada’s gift to the world – saving the lives of up to 200 million people globally.

As we prepare to mark the 100th anniversary of this life-saving drug, we know that research and clinical trials cannot stop. That is why we are asking the government to make a commitment to move beyond insulin and towards prevention and cures by committing to renew crucial funds for T1D research.

In 2017, the government committed $15 million to a new Partnership to Defeat Diabetes between JDRF and the Canadian Institutes of Health Research (CIHR), in order to improve the lives of Canadians with T1D and drive efforts to find a cure. Matched with $15 million from JDRF, this funding will support at least 11 high impact, internationally relevant projects. Five projects are currently underway and six more commence next year.

This year, our 2021 Federal pre-budget submission includes three recommendations, including the renewal of funds with the Canadian government in order to remain the world leader in T1D clinical trials, transnational research and tools to prevent, treat and ultimately cure T1D.

Funding for this partnership will include:

  • Prevention of diabetes, especially in children and youth;
  • Early treatment of diabetes, thereby delaying its progression and reducing the risk of complications;
  • Accelerating development of diabetes device technology to enable automated insulin delivery, including in special populations;
  • Leveraging data using various approaches, such as artificial intelligence, to drive development of personalized treatment of diabetes and its complications.

We hope to have an opportunity to testify in front of the Standing committee on Finance’s pre-budget consultations committee, and these same recommendations will be relayed to MPs and senators as part of this year’s 2020 Kids for a Cure home Edition.

While we send over 30 delegates to speak to decision-makers in our Kids For a Cure Lobby Day Home Edition, you can take part in it too by speaking out about the need to accelerate the pace of research through funding from our federal government. Share your message on social using #KidsForACure2020 and tell lawmakers why this is important! There is strength in numbers, and we know that together, we can turn type one into type none. 

Help us continue to advocate for the T1D community

More choices for our T1D community: New Pumps Approved in BC

August 26, 2020

There’s good news for pumpers in BC! BC Pharmacare has added YpsoPump by YpsoMed to its Tier 1 list of approved insulin pumps. BC residents with type 1 diabetes of all ages can now choose between the Omnipod by Insulet or the YpsoPump under the province’s pump program.  

Thanks in part to our JDRF Advocates, the province has also added the Medtronic MiniMed 670g to its list of Tier 2 pumps. Medtronic pumps can be obtained under a special exemption based on a recommendation from the person’s doctor or endocrinologist. Patients may be responsible for paying some of the cost for a Tier 2 device.

Nearly 400 JDRF Advocates responded to our action last summer urging the BC government to add the Medtronic 670g and the Tandem t:slim X2 to their list of approved pumps. While Tandem’s pump is still not available through BC Pharmacare, the addition of the Medtronic 670g is a small victory for our community’s choice and means that some of the costs for this device will be covered.

At JDRF we continue to push for expand access to the medical technologies – insulin pumps and advanced glucose monitoring systems – that Canadians with type 1 diabetes need. We hope that one day soon sensors too will be covered. To learn more about JDRF’s #AccessForAll campaign check out jdrf.ca/accessforall.

Access For All Goes West

August 26, 2020

JDRF’s attention has been focused on Canada’s west coast increasingly as the BC government inches closer to a decision on whether or not to cover continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) systems. BC Pharmacare commissioned a health technology assessment on these technologies more than a year ago but the results have yet to be released.

Things began heating up this spring for JDRF’s #AccessForAll campaign with youth Advocate Sage Stobbe’s testimony to BC’s pre-budget committee in support of JDRF’s 2021 Pre-Budget Submission studying these technologies for more than a year now. The Victoria teen testified about the daily “battles” she and others with type 1 diabetes (T1D) face against “unpredictable high and low blood sugars”. She also appealed to them on a cost-benefit basis pointing out that she often uses up to 15 blood strips in a single day, much higher than the cost of sensors for either FGM or CGM. Listen to Sage’s testimony here (she comes on around 08:10:30 am).

This summer JDRF made formal written submissions to the Canadian Agency for Drugs Technology and Health with respect to two different draft reviews of flash glucose monitoring, the first summarizing clinical and cost effectiveness evidence, and the second based on feedback from a panel of clinicians. 

We’ve also partnered with Diabetes Canada and Type 1 Together to develop a joint submission to the BC Pharmacare Your Voice patient consultation that was launched this August. The three diabetes organizations met with officials from BC Pharmaceutical Services Division via Skype to better understand the process and contribute feedback on behalf of the diabetes community.

Do you live in BC and have type 1 diabetes? Contribute your feedback in the Your Voice patient survey. If you’re a caregiver, the BC government would like to hear from you as well. Have your say via the caregiver survey.

Help us continue to advocate for the T1D community

London, UK sees localized increase in pediatric T1D diagnoses – but experts say too early to blame COVID-19

August 19, 2020 

A recent increase in type 1 diabetes (T1D) diagnoses in children under 18 in some hospitals in north-west London, UK, has triggered news stories that COVID-19 could cause the disease in children. But experts have stressed that the locally reported increase in diagnoses is not yet clearly linked to the pandemic. 

In the new study, 30 children at five hospitals across north-west London presented with new-onset T1D during the peak of the pandemic, approximately double the number of cases typically seen in this period in previous years. Increased cases were clustered in two of the five hospitals. 

21 children (70%) were tested for COVID-19, and only 14 (47%) had antibody tests to see whether they had previously been exposed to the virus.  Five (17%) of the children with newly diagnosed T1D had evidence of past or current coronavirus infection. 

No clear link between COVID-19 and T1D yet

Scientists have long suspected viral infections could play a role in triggering T1D – at least in some people. The authors of the study recommend a larger analysis to establish whether there is a definitive link between COVID-19 and new-onset T1D, and if so whether COVID-19 has any impact on the severity of the disease. 

Prof Deborah Dunn-Walters, Chair of the British Society for Immunology taskforce on COVID-19 and Immunology, said in a responsive statement: “This paper reports an increase in the number of type 1 diabetes cases in children in part of London during the months of April and May compared with previous years. As not all children in the study were tested for COVID-19, the findings do not show that this increase was linked to the COVID-19 pandemic – in fact, it is currently unclear what was behind this rise in cases.” 

Prof. Dunn-Walters said further: “Currently, there have been no comprehensive studies published linking COVID-19 to the development of any autoimmune disease, including type 1 diabetes. However, we are still in the early days of finding out about the longer-term effects of COVID-19 and follow-up studies in this area will be important.” 

The findings from the UK study contrast with those of studies from other parts of the world that instead suggest delayed diagnoses of T1D during the pandemic due to fears about accessing healthcare. For example, a recent report from Italy indicated that pediatric diagnoses of T1D in children were decreased 23% during the peak of the pandemic compared with the same timeframe in 2019, with a greater proportion presenting with diabetic ketoacidosis (DKA). However, the Italian study did not rigorously address whether COVID-19 may have been a precipitating factor to T1D diagnosis. 

Diane Wherrett, Professor and pediatric endocrinologist at The Hospital for Sick Children in Toronto, says: “This observation based on a very small number of cases suggests that diabetes researchers and care providers should examine larger national databases, particularly in countries with high rates of COVID-19, to determine if changes have been seen. Given that type 1 diabetes develops over many months to many years, it is very unlikely that COVID-19 triggered the process that causes type 1 diabetes.” 

Each person with T1D is different. If you are concerned about your health status and have questions about your own situation, seek guidance from your healthcare team. You can also write to us at T1Dquestions@JDRF.ca  or check out jdrf.ca/coronavirus for more information. 

Type 1 diabetes and COVID-19: Going back to school

August 17, 2020 

Download this document here.

As students across Canada get ready to head back to school—some after nearly 6 months of being away—parents have many questions. The first is usually, “Is it safe to send my child back to school during this pandemic?”

Here are some things to consider when making a decision about sending your child with type 1 diabetes (T1D) back to school.

  • The situation in your community: The risk ofillness in schools depends to a large extent on how much virus is in a community. Your local public health authority is the best source of this information that can help you decide what the overall risk of illness is for all students.
  • The protocols your school has in place: Preventing students and school staff from getting the virus in the first place is the top priority. How is your school ensuring they are following public health guidance to create safer spaces?
  • Risk of your child getting sick: Type 1 diabetes is an autoimmune condition. This is not the same as being immune suppressed or immuno-compromised, which increases risk of COVID-19. Children with well-controlled type 1 diabetes face the same risk of getting COVID-19 as their peers without T1D. If children with T1D do get the virus, they are not at a higher risk of complications. But any virus may cause blood sugars to be higher, so proper sick day management is essential.
  • How you feel about the risk of illness: During a pandemic, there are many things we can do to reduce our chances of getting sick. But as long as the virus is in a community, there will always be some risk. Everyone feels differently about risk. Ask yourself whether you would be comfortable sending your child to school if they did not have type 1 diabetes.
  • The risk of serious illness and death: Children with COVID-19 infections have rarely become sick enough to be admitted to hospital. In fact, the chance of a child being hospitalized with COVID-19 maybe lower than it is for influenza, a virus that occurs in the community each year.
  • Your child’s overall health and well-being: The long and unexpected school closures, along with other restrictions on activities and socializing, may affect children’s physical, social, and emotional well-being. When deciding whether to choose remote learning or inperson schooling, think about how your child has done over the past few months.
  • Supports for your child with diabetes: Students with diabetes have the right to be safe, supported, and included at school. A global pandemic does not change this. Will your child be well supported in managing their day-to-day diabetes tasks?

 

Key Points

Type 1 diabetes is an “auto-immune” disorder. This does not mean that people with T1D have a weakened immune system. Children with well-controlled T1D are
not at an increased risk of getting COVID or of more severe COVID illness. Many factors will go into the decision about returning to school, including local conditions, your family situation, your child’s learning style and temperament, and so on. While each family’s situation is different, type 1 diabetes alone should not be considered a medical reason to delay return to school or work. Consider whether your child will receive the supports they need to help manage their diabetes during the school day.

 

Are children with type 1 diabetes at higher risk of contracting coronavirus?

You may have heard that people with diabetes are at higher risk of developing complications from COVID-19. This is based on information about adults, mostly with type 2 diabetes and not youth with type 1 diabetes. While we lack specific evidence about type 1 diabetes and COVID-19, leading medical experts say that children (and adults under 65 years) with well-managed type 1 diabetes are NOT at increased risk of contracting COVID-19 or developing serious complications from it.

 

How do I keep my child with type 1 diabetes safe at school?

Take steps to prevent getting coronavirus

When it comes to keeping students safe from COVID-19, all Canadian schools should have measures in place to help stop the spread of the virus. These will vary depending on what part of the country you are in and what is happening with infection rates in your community. Some ways that schools are helping to reduce the risk of COVID-19 include:

  • Smaller class sizes or cohorting (keeping small groups of students together for the day)
  • Frequent handwashing and/or hand sanitizing
  • Enhanced cleaning and disinfecting of schools, especially surfaces that are frequently touched
  • Physical distancing
  • Wearing masks or cloth face coverings
  • Changes to school schedules or other school-day routines
  • Not sharing personal or school-owned items like supplies or musical instruments
  • Limiting the number of people coming into the school
  • Reducing other high-contact situations, such as bus transportation (by driving, walking or cycling to school)

Help your child become familiar with the guidelines for their school and be sure they know what to do. Check your child every day for symptoms of coronavirus, and keep them home if they have symptoms or are sick.

 

Ensure your child has a diabetes care plan in place

The most important tool for keeping your child with diabetes safe at school is an Individual Care Plan. Many boards have their own forms, or you can use the one on the Diabetes@School website.

The care plan includes all the details of daily diabetes management at school including: when and where to do blood sugar checks and give insulin; how to deal with low and high blood sugars; and who has been designated to provide support to the student. Before school starts, make sure this plan is up to date, and ask your clinic for help if you need it.
If your child requires support for lunchtime insulin from an adult who is not on the school staff, ensure that you contact the school about these arrangements before school starts, since schools may be limiting the number of people allowed on site.
School staff will also need education or training to support your child. The Diabetes@School website has many tools, such as videos, that make it easy to do this training virtually or online if you are unable to do it in person.
Encourage your child to be extra vigilant with hand hygiene, especially when they are checking blood sugars, using their insulin pump, or doing any other diabetes task. You may want to include some extra hand sanitizer and/or wipes in their kits, as well as extra masks or gloves in case an adult at the school needs to provide help.

 

What if my child gets COVID-19?

Having any virus or illness can affect blood sugars in people with type 1 diabetes. Since the chance of high blood sugar and ketones are increased when your child is ill, make sure you are familiar with sick day guidelines. In particular, know:

  • How to check for and manage ketones, which can develop with high blood sugar. You can use a blood ketone meter or urine strips. Ensure you have supplies on hand at all times and be sure to check expiry dates.
  • How to prevent DKA (diabetic ketoacidosis), a serious complication of diabetes that needs hospital admission caused by not having enough insulin.
  • How and when to use mini doses of glucagon, for children with low blood sugar who are vomiting and cannot take fast-acting sugar. If your clinic has not trained you to do this, ensure you know when to call for help. Have an injectable glucagon kit on hand, even if you have a nasal glucagon product (Baqsimi) as well.

Since anyone with viral symptoms must stay quarantined for 14 days, be sure to always have a supply of prescriptions and diabetes medications at home.

 

How can I prevent DKA?

Symptoms of DKA (diabetic ketoacidosis) include abdominal pain, nausea, vomiting, high blood sugar and ketones (which cause fruity-smelling breath, and laboured, rapid breathing). Without treatment, DKA can be life threatening.
Here are some things you can do to prevent DKA:

  • If your child is sick and/or has ketones, follow your clinic’s sick day guidelines.
  • NEVER stop insulin: During an illness, even if your child is not eating well, insulin needs are usually higher.
  • If your child uses an insulin pump, make sure you have either syringes or an insulin pen on hand, in case you need to give fast-acting insulin by injection. Have a supply of basal (long-acting) insulin on hand in case your child’s pump malfunctions.
  • Keep your child well hydrated with sugar-free fluids.
  • Seek help from your team as directed.

If your child is showing signs of DKA, you need to seek medical attention immediately.

 

What else can I do?
  • Do what you can to prevent all family members from contracting coronavirus. That includes practicing physical distancing, hand hygiene, and wearing masks—especially when inside and when physical distancing is not possible. Follow the advice of the Public Health Agency of Canada and your local public health authorities.
    • To help minimize possible exposure, know what others in your circle are doing to prevent illness, including child care providers, friends outside of school, and extended family. If your child is taking part in extracurricular activities, ask what precautions are being taken.
    • Don’t send your child to school if they have any symptoms of coronavirus.
    • Ensure all your child’s vaccines are up to date and that they get an influenza vaccine as soon as they are available in the fall.

 

For more information:

 

www.diabetesatschool.ca

 

www.jdrf.ca

 

www.diabetes.ca

 

Developed by Diabetes@School (Canadian Paediatric Society, Canadian Pediatric Endocrine Group, Diabetes Canada) and JDRF Canada, in collaboration with the diabetes teams from the Children’s Hospital of Eastern Ontario (Ottawa) and the IWK Health Centre (Halifax).

 

Landmark trial of T1D-related kidney disease misses primary outcome, but provides valuable lessons

August 10, 2020

In recent years, better ways to control blood sugar levels and blood pressure have led to a decrease in kidney-related complications among the type 1 diabetes (T1D) population. However, kidney disease remains one of the leading complications of diabetes, including the need for dialysis or kidney transplant. Identifying strategies to reduce kidney complications has been a key focus of JDRF’s research strategy. To date, several studies have demonstrated that individuals with higher levels of uric acid in their blood are more susceptible to reduced kidney function. This led to the Preventing Early Renal Loss in Diabetes (PERL) trial, a joint initiative between investigators across North America and Denmark. Partly funded by JDRF, the three-year study involved testing allopurinol – a drug that has been on the market since the 1960s to reduce uric acid levels in gout – in 530 participants with T1D and early to moderate kidney disease. On the basis of years of evidence, including a promising pilot trial supported by JDRF, the hypothesis was that allopurinol would reduce the incidence or severity of kidney disease in people with T1D.

Throughout the placebo-controlled trial, the key measurement of kidney function for patients was the glomerular filtration rate (GFR), which gauges how much blood is filtered every minute by the kidneys – a measure that drops as kidney function gets worse. The study’s findings revealed that levels of uric acid fell about 35 per cent on average among people given allopurinol over the course of three years compared with those who did not receive the drug. However, allopurinol had no impact on GFR leading investigators to conclude that it does not prevent T1D-related kidney disease.

“This is not the result that we wanted,” said Peter Senior*, a researcher at the University of Alberta and PERL collaborator, “but it does give a very clear answer to an important scientific question.” 

Clinical trials that specifically set out to measure kidney outcomes are relatively rare in T1D. The PERL trial was a true landmark by demonstrating that kidney trials can successfully be done in people with the disease. Moreover, the existing trial infrastructure and cohort, as well as learnings from the study, will be leveraged for future trials with other drugs.

“PERL was a textbook example of taking clinical observations and preliminary research findings suggesting the potential for a new use for an old drug, and then designing a study to definitively answer whether or not the drug would prove to be effective as a new treatment,” Senior* noted. “In this case, the drug did not show any of the anticipated benefit. But that is exactly why we do clinical trials, and how our scientific understanding advances. We don’t want to recommend treatments because ‘in theory’ they should work.”

Work to uncover ways to reduce the risk of kidney complications in T1D continues. JDRF is currently funding follow-up studies on biopsies from PERL trial participants, to obtain a better understanding of T1D-related kidney disease. In addition, a JDRF-funded Australian phase 2 trial is testing a completely new drug (referred to as GKT137831) in adults with T1D and early signs of kidney impairment. This drug works by reducing damage to the kidney caused by oxidative stress at the cellular level. The hypothesis is that reduction of oxidative stress by GKT137831 will prevent or slow decline in kidney function in people with T1D involved in the trial. Finally, JDRF Canada is funding a clinical trial of an oral drug called dapagliflozin that can be taken alongside insulin, with the aim of reducing biomarkers of complications, including kidney complications, in adolescents with T1D.

*as quoted in Folio, the University of Alberta’s daily digital magazine