Are We There Yet? Finding Ways to Work Together on T1D.

Abstract

All parents know the question “Are we there yet?” when on a long drive with kids in the back of the car: an expression of impatience and not understanding why it takes “forever.” Reality is often different than the perception of those in the back seat: we are driving as fast as speed limits allow, and we only left home a couple of hours ago. The same feeling is present when clinicians speak with people with type 1 diabetes (T1D) and their families. Why does it take so long? Why haven’t you cured this disease? It becomes worse when other health care professionals come into the picture, in particular health care professionals who know of “success stories” close to biblical proportions, as in rheumatoid arthritis or inflammatory bowel disease. We find many answers in the article by Bingley et al. (1) in this issue of Diabetes Care . Dr. Bingley, one of the clinicians leading the long-term battle against T1D, has described together with her TrialNet colleagues what this initiative has achieved in the past decades. Importantly, they also give us glimpses of where they feel the field should go. The long list of interventions tested in TrialNet confirms that we have not failed in preventing or arresting T1D for lack of trying but indicates that T1D has several specific hurdles that prevent us from reaching success (2). Hurdles include the lack of accessibility of the target organ (the insulin-producing β-cell buried in the islets of Langerhans in the pancreas), making direct histological observations or staging of the immune attack or level of β-cell destruction impossible in individual patients. What we did learn is that T1D is probably not the result of a single path to β-cell destruction (3). Heterogeneity exists, in the speed of onset, in the progression of …