Type 1 diabetes

Does immunotherapy scare you?

Wednesday, 30 Aug 2017

Dust off your medical textbooks or hang out with a rheumatologist because the future of diabetes treatment lies in immunotherapy, an international expert has told ADS delegates in Perth.

Delivering the ADS and ESA plenary lecture, Dr Carla Greenbaum from the Benaroya Research Institute in Seattle, said clinicians caring for people with type 1 diabetes should learn about disease modifying therapies as they will “be part of the future of diabetes care”.

This was because a number of trials were adding to evidence that type 1 diabetes should be thought as of a disease with stages – starting from immune activation, to immune response, through to four different stages of disease.

Changing from symptom management to disease modifying therapy required the use of immunotherapy, said Professor Greenbaum who is chair of the Type 1 diabetes TrialNet, an international consortium of experts dedicated to the prevention of type 1 diabetes.

“One of the challenges as endocrinologists is that immunotherapy seems a little scary because we don’t use it in clinical practice, we’re not comfortable with it,” she said.

“There is a long list of immune mediated or autoimmune diseases and there are very few that are not treated with immunotherapy…so we have a problem in endocrinology in how we think about immunotherapy”.

According to Dr Greenbaum, one issue is that endocrinology training doesn’t provide clinicians with skills and knowledge in this area.

“We don’t have experience with the use of these therapies, just as our rheumatology friends would be totally decompensated if they had a patient in hospital with an insulin pump,” she said.

Dr Greenbaum told delegates that they needed to be familiar with immunology, particularly delegates born after 1990, as immunotherapy will be a part of diabetes clinical practice in their lifetime.

“I tell young fellows that they shouldn’t just hang out with a rheumatologist but they should do their best to find one and marry them,” she said, eliciting peals of laughter from the audience.

“For those of you who don’t have that opportunity spend some time hanging out with rheumatologists and try and gain clinical experience and talk to people with expertise in this area,” she advised.

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