In Type 1 Diabetes, Pancreas Size May Predict Disease Progression

The size of the pancreas may be a marker for the risk of disease progression in patients with type 1 diabetes, finds a new study published in Diabetes Care, the journal of the American Diabetes Association. Researchers at the Vanderbilt Diabetes Research and Training Center (DRTC) have found that a smaller pancreas leads to faster progression to stage 3 type 1 diabetes. The findings suggest that imaging of the pancreas can be used to track disease progression.

Type 1 diabetes is an autoimmune disease that affects about 1% of the population. In type 1 diabetes, the pancreas does not make insulin. The disease has three stage: stage 1, where patients are presymptomatic with normal blood glucose levels; stage 2, where patients are presymptomatic but have developed glucose intolerance; and stage 3, where patients develop symptoms that include increased hunger and thirst, blurry vision, fatigue, and diabetic ketoacidosis, a complication in which acids build up in the blood.

Jack Virostko, Ph.D.

“If we can better predict the progression to stage 3, our hope is that we can better identify and apply therapies to slow or even stop the advance of the disease, even before diagnosis,” lead author Jack Virostko, Ph.D., said in a news release. He is assistant professor of Diagnostic Medicine in the Dell Medical School at the University of Texas at Austin and formerly with the Vanderbilt University Institute of Imaging Science.

Accurate disease prediction is important, researchers said, because of the approval of the first therapy to delay diabetes. Developed by Provention Bio, Tzield (teplizumab-mzwv) was approved by the FDA in November 2022 to delay the onset of stage 3 type 1 diabetes. Tzield is anti-CD3-directed antibody. It binds to CD3, a cell surface antigen present on T lymphocytes. Sanofi acquired Provention Bio in April 2023.

The investigators in the Diabetes Care study collaborated with TrialNet, a research network funded by the National Institutes of Health that investigates how type 1 diabetes. For this study, the pancreas volume of 65 TrialNet participants was determined by using non-contrast magnetic resonance imaging (MRI), metabolic scores from oral glucose tolerance testing and a combination of pancreas volume and metabolic scores to predict progression. The MRIs were performed at six- and 12-month intervals.

Researchers found that pancreas volume did not correlate with metabolic testing. They suggest this is because pancreas volume and metabolism reflect distinct components of risk for developing stage 3 type 1 diabetes. They indicated that pancreas volume, coupled with metabolic measures, can better predict disease progression either MRI imaging or glucose testing alone.

“We, therefore, created a prediction model with both pancreas volume and metabolic measures, and this model outperformed imaging or metabolic testing alone for predicting progression to stage 3 T1D,” they wrote.

Researchers said that one limitation was the small sample size. They said a larger number of MRIs would be needed to determine whether the scans can be generalized. Additionally, the patient population studied were mostly non-Hispanic White, and additional research is needed to see if these results apply to other patient populations.

The cost of MRI may limit its use as a screening tool for those at risk of disease progression in type 1 diabetes, but also doesn’t require patient fasting or blood samples.