Ever since insulin was used for the first time in Toronto in 1921, Canada has led many research projects that have helped to advance knowledge, treatments and technologies for type 1 diabetes (T1D). In Quebec, several healthcare and research centres are involved in advancing science and gaining a better understanding of the condition.
Maisonneuve-Rosemont Hospital: A new drug for diabetic retinopathy
Diabetic retinopathy is one of the most dreaded complications of diabetes. It causes damage to small blood vessels in the eyes, and can occur when blood sugar levels remain high over an extended period (several years). Up to 30% of people with type 1 diabetes are at risk of this complication, whose most severe forms lead to reduced vision or even blindness.
Retinopathy is treated through adequate blood sugar and blood pressure management, along with oral drugs (fenofibrate), laser treatments or eye injections, in some cases. In the early stages, one of the challenges of treating the condition is differentiating affected blood vessels from unaffected ones. For that reason, a research team at Maisonneuve-Rosemont Hospital, in collaboration with Unity Biotechnology, has developed a promising new drug. This drug contains a molecular target that can pinpoint and eliminate affected blood vessels, which helps to maximize the retina’s natural healing process and facilitate recovery.
According to the researchers, a single injection of this drug has the potential to significantly improve the treatment of diabetic retinopathy. Human studies are still pending, which means this drug won’t be available before long, but it’s a promising and hope-inspiring treatment.
CHU of Quebec: Liraglutide for people with type 1 diabetes
GLP-1 analogs are a class of drugs that are increasingly prescribed to people with type 2 diabetes (T2D). These drugs slow down digestion and make patients feel fuller faster, which leads to weight loss and improved insulin secretion. Of course, people with T1D cannot benefit from the effects on insulin secretion. Among people with T2D, this class of drugs leads to decreased glycated hemoglobin (HbA1c), and for those with heart complications, a lower risk of cardiac relapse. Most drugs in this class require once-daily or once-weekly injections. In Canada, this treatment has not been approved for people with T1D. The CHU of Quebec has conducted a study to assess the efficacy of a GLP-1 analog called liraglutide (VictozaⓇ) among T1D patients who also had excess weight. The goal of this research study was to assess whether the treatment would yield results similar to those observed among T2D patients. The study showed that liraglutide leads to an increase in the sensation of satiety and a decrease in potentially damageable eating behaviours. This is one of many studies on the topic that could help to improve access to GLP-1 analog drugs for people with T1D. Many studies are being conducted to determine whether drugs developed for people with T2D could benefit people with T1D, in particular biguanides (metformin), and SGLT2 inhibitors, a class of drugs (InvokanaⓇ, JardianceⓇ and ForxigaⓇ) that help to eliminate part of the excess glucose (sugar) through urine.
Montreal Children’s Hospital: Risk of psychiatric disorders among young adults with diabetes
Transitioning from pediatric medical facilities to adult care settings is often challenging for teenagers who have T1D. The specific needs of young adults are not always adequately taken into consideration, and the support provided by their healthcare teams for managing their T1D is sometimes ill-adapted. Managing T1D can represent an added burden on top of all the other challenges (academic, professional, social, etc.) that young adults generally have to face. That’s why a research team at the Montreal Children’s Hospital decided to look at the prevalence of psychiatric disorders, such as depression and eating disorders, among this group of patients.
The researchers noted that teenagers and young adults with T1D had a 33% greater risk of having psychiatric disorders than other non-diabetic youth. The study also reported that the risk of suicide is three times higher among young adults with T1D than among the general population.
This alarming discovery highlights the importance of improving practices and providing support that is better tailored to young adults going through this transition. This could take the form of closer monitoring during this period, while paying particular attention to emotional issues that the management of T1D can generate.
Montreal Clinical Research Institute (IRCM) and McGill University: BETTER project and related studies
About three years ago, a research team from MCRI and McGill University launched the BETTER project in partnership with people who have (or have a child who has) type 1 diabetes. This project has a dual purpose: helping to reduce the burden of hypoglycemia through better information and clinical studies, and filling a glaring gap, i.e., the fact that we have no idea how many people have T1D in the country or in the province. This means that the estimates used by public health authorities may not correctly represent the size and the specific needs of this population. By creating a registry that invites everyone to sign up, the BETTER project wants to provide a more adequate representation of the number of people who live with T1D in Quebec. Anyone who has T1D or has a child with T1D in Quebec can sign up and help advance research. It’s crucial that as many people as possible sign up for the registry to paint an accurate picture of the current situation, and to help more accurately represent the issues that they are facing and that are not being addressed, or properly addressed. This data is needed not only to improve the provision and nature of care, but also to advocate for the interests and rights of people with T1D, in particular among governmental officials.
More than 1,800 people have signed up for the registry so far. Preliminary analyses are underway on topics such as the frequency of hypoglycemia episodes, stigmatization (related to T1D, treatments or hypoglycemia), low-carb diets (potential benefits and risks), technology use, etc.
Our project also includes several clinical studies on hypoglycemia to which people with T1D are invited to contribute. For instance, we would like to find out whether the “15 grams of carb per 15 minutes” rule for treating hypoglycemia should be reviewed, or compare various types of currently available artificial pancreases.
- Dubé, M. C., D’Amours, M., & Weisnagel, S. J. (2020). Effect of LIRAGLUTIDE on food consumption, appetite sensations and eating behaviours in overweight people with type 1 diabetes. Diabetes, Obesity and Metabolism, 22(8), 1417–1424. https://doi.org/10.1111/dom.14050
- Robinson, M.-E., Simard, M., Larocque, I., Shah, J., Nakhla, M., & Rahme, E. (2019). Risk of psychiatric disorders and suicide attempts in emerging adults with diabetes. Diabetes Care, 43(2), 484–486. https://doi.org/10.2337/dc19-1487
- Rétinopathie diabétique : NOUVEAU traitement prometteur. Fondation de l’Hôpital Maisonneuve-Rosemont. (2021, May 17). https://www.fondationhmr.ca/fr/ophtalmologie/retinopathie-diabetique-nouveau-traitement-prometteur/.
- Accueil. BETTER. (2021, July 29). http://www.type1better.com/.