By Anne-Katrine Boström

Published 11 February 2020

As the number of people diagnosed with type 1 diabetes continues to rise, scientists are still struggling to understand what causes the disease - and how to prevent or cure it.

At Novo Nordisk, we’re investing significant resources into improving our understanding of type 1 diabetes in hopes of discovering a cure or reversal therapy – a long-held aspiration for the company. But this is no easy task, as our chief medical officer Stephen Gough explains.

“What we are seeing right now is a 2-5% rise in the global incidence of type 1 diabetes each year; this means that in the US alone, 1 in every 300 teenagers lives with the disease,” he says. “So this really is a significant problem, and right now the only available treatment is insulin.”

“Scientifically, we are now approaching this from three angles: how we can prevent people from getting type 1 diabetes in the first place? How we can preserve insulin production in newly diagnosed people? And how - by using stem cells - we can replace the insulin producing cells in the pancreas and thereby provide a curative treatment?”

At our research facility in Seattle, a team led by Johnna Wesley, head of type 1 diabetes, immunology and kidney disease research, is looking into the possibilities of preventing or delaying the onset of type 1 diabetes.

“When we’re talking about prevention for type 1 diabetes, we’re trying to stop the islets in the pancreas from being destroyed by the immune system,” she explains. “The disease itself starts when immune cells make their way into the pancreas when they’re not supposed to be there. We’re trying to prevent those cells from getting to the pancreas in the first place, or at least prevent them from destroying insulin-producing cells if they make it through.”

Johnna believes that even a therapy that can delay the onset of the condition could make a significant difference for many people.

“Our goal is to give people a year, five years, or even 10 years to get a little older, a little more mature – to get them to a point where they’re better equipped to manage their disease and delay or reduce the potential need for insulin therapy.”

Johnna and her team have made significant progress, and in a relatively short time have managed to bring some of their research into clinical trials. And even though a curative or preventative therapy is still some way off, she is confident that it will one day be possible.

“I’m confident that it is possible to delay the disease,” she says. “It may not be a one-size-fits-all therapy, probably a one-size-fits-most, but I’m convinced it can be done.”

In the stem cell R&D unit, Jacob Sten Petersen, and his team are taking a different approach in the quest to defeat type 1 diabetes. Working with stem cells, they are trying to find a replacement cure for the lost insulin producing beta cells, which are destroyed during the development of type 1 diabetes.

Within the last few years, the unit has made significant progress - but has also encountered challenges.

“Right now, we have reached the point where we are able to produce cells; cells that can produce insulin and cells that can lower blood sugar in mice,” Jacob explains, adding that the challenge now is to replicate this effect in the human body.

“Our biggest challenge right now is to find a device that can protect these new cells from being killed by the immune system, which is what causes an individual to get type 1 diabetes in the first place. This might sound simple, but it really isn’t.”

In fact, Jacob explains, it has proven to be a bigger challenge than the team first thought. They are now working with several external expert collaborators, and Jacob remains optimistic.

“We are aiming to start clinical testing in humans within a couple of years,” he said. “And I am positive that we will reach our goal to find a cure in the end. But it will take us time, and there will be plenty of ups and downs before we get there.”

Whilst Stephen Gough is excited and optimistic about the work Novo Nordisk is spearheading, he remains acutely aware of the challenges that lie ahead.

“When we are talking about prevention and or delay of type 1 diabetes, one of our biggest challenges is that we do not have an effective screening programme,” he says. “Basically, we need to understand and identify those who are at the highest risk of developing type 1 diabetes, in order to be able to understand how our research can make a difference. Until we have developed such a programme, the task remains a very difficult one.”

Although scientists are working with hypotheses about different causative factors, we still do not completely understand what is causing a rise in the number of people developing type 1 diabetes.

However, he is optimistic that Novo Nordisk will be able to crack the nut eventually.

“Even though an actual treatment is still a number of years away, we are making a lot of progress, and see great promise in our ongoing clinical trials. I’ve no doubt we’ll get there in the end.”