Using New Therapies and Interactive Technologies to Reduce Hypoglycemic Risk

The BETTER (BEhaviors, Therapies, TEchnologies and hypoglycemic Risk in Type 1 pediabetes) project is focused on measuring and reducing hypoglycemia in people with T1D.

Dr. Rémi Rabasa-Lhoret  (Institut de recherches cliniques de Montréal)  and his team have developed a registry of people with T1D to identify the needs and realities related to the disease. As of March, 2021 the registry included more than 1500 people with T1D. They are also conducting several small trials testing new approaches for hypoglycemia treatment.

Improving Glucose Control and Preventing Complications in Adolescents with T1D

Dr. Farid Mahmud (The Hospital for Sick Children) is leading a clinical trial that is testing the effects of dapagliflozin (a drug currently approved for use in type 2 diabetes and known for its metabolic and health benefits) added to insulin therapy in adolescents and young adults with T1D who are at a higher risk of developing complications, such as kidney and heart disease. Dapagliflozin reduces the amount of glucose the kidneys reabsorb into the blood, thereby allowing more to pass through the urine, improving glucose control.

Improving Outcomes for Persons with T1D using a Novel Virtual Care Platform

Dr. Gillian Booth, (Centre for Urban Health Solutions within the Li Ka Shing Knowledge Institute of St. Michael’s Hospital) is exploring a new approach to T1D care in the Type 1 Diabetes Virtual Self-Management Education and Support (T1ME) trial.

In this trial, Dr. Booth and her team are testing whether a new digital platform that optimizes the way health care is delivered to people with T1D can improve glucose control and patient experiences. The platform has been developed in consultation with people living with T1D and includes a “virtual library” about T1D management.

Cell Replacement Therapy Without Immunosuppression

Dr. Maria Cristina Nostro (McEwen Stem Cell Institute at University Health Network) and her team are developing new transplantation strategies and universal donor stem cells to develop a superior islet-like product for people with T1D that will require little or no immunosuppression.

Dr. Nostro’s team will leverage their expertise in stem cell biology, vascular biology, islet transplantation and beta cell biology to address these challenges and work to develop a safe and effective clinical-grade product for therapy. The outcome from these studies will accelerate universal donor stem cell-based T1D therapies.

Scaling up and Refining a Designer Cell Replacement Product

Dr. Francis Lynn (University of British Columbia and BC Children’s Research Institute) has assembled a team that will create insulin-producing cells from human stem cells. By combining expertise in single-cell technologies, genome editing, immunology, and stem cell and islet biology the team will produce a new and improved cell source for cell replacement therapy for T1D. Ideally, the new cell source will be ready for clinical trial testing in a few years.

Gaining Insights into the Causes of T1D by Studying the Gut Microbiome

New cases of T1D are on the rise, and there is little doubt that our environment plays a role. The gut microbiome – the complex community of bacteria that live in the intestine – has emerged as a potentially important factor in determining risk of T1D.

Dr. Jayne Danska  (Hospital for Sick Children) is leading a multidisciplinary team that will examine how different microbes protect from or potentiate T1D, what these microbes do in developing infants, which will inform development of new therapeutics that prevent or treat the disease – advancing towards cures.

Unravelling the Immunology of T1D to Uncover New Avenues to Cure

In this Team Grant, Dr. Megan Levings (University of British Columbia and BC Children’s Hospital Research Institute) brings together an all-star cast of Canadian T1D researchers to undertake studies that address questions including: what are the essential immune regulatory networks that become compromised in people with T1D? How can we restore these networks to stimulate beta cell regeneration and cure T1D?

The team is collecting and studying samples from dozens of people with T1D, as well as people at risk of T1D, to identify the breaches in normal immune regulation that cause the disease. In parallel, the team will also explore new approaches for immune cell therapies that could cure the disease.

Building CAPACIty for pediatric diabetes research and quality improvement across Canada

Dr. Shazhan Amed (BC Children’s Hospital) and her team have created the CAnadian PediAtric diabetes Consortium (CAPACIty) – a network of 15 childhood diabetes centers from across Canada – to jointly design and develop a Canada-wide childhood diabetes registry and research platform. With close involvement of patients, families, and healthcare providers, the registry will improve diabetes care and health outcomes for Canadian youth with T1D. The registry will provide comparison of diabetes care quality and outcomes between Canadian diabetes centers, quality improvement initiatives, patient-informed research initiatives across Canada, and advocacy work.

Developing personalized diabetes therapy: A first-in-human trial of autologous induced pluripotent stem cells (ipsc)-derived islets

Dr. James Shapiro (University of Alberta) and his team will develop a stem cell-based therapy to replace or supplement damaged B-cells in people with all types of diabetes.

They propose to manufacture new B-like cells from patients’ own blood cells so that they will be accepted by the immune system and no/minimal anti-rejection drugs are needed. In this project, they will conduct a first-in-human trial to implant these cells under the patient’s skin and evaluate their safety and preliminary efficacy.

Being able to transplant an unlimited supply of self-derived islet cells without immunosuppressants is a novel approach to treat all forms of diabetes.

A deep phenotyping network for understanding human islet variation in health and diabetes

Dr. Patrick MacDonald (Canada Research Chair; University of Alberta) and his team

seek to understand the variability in human islet function in relation to genetic and environmental impacts on diabetes risk and to identify mechanisms of islet dysfunction in diabetes. To do this they will take advantage of extensive data on the molecular, cellular, and physiological function of islets from human organ donors. They will also produce tools and resources so that other researchers can explore this data to answer their own questions about islet dysfunction in diabetes.

Designing stem cell-derived islets for diabetes therapy

Dr. Tim Kieffer (University of British Columbia, Breakthrough T1D Centre of Excellence) and his team are manufacturing stem cell-derives islets for transplantation. To date, islet transplantation has been a very successful procedure, but is hindered by the need for donor islets and ongoing immunosuppression therapy.

Over the past several years, there have been remarkable breakthroughs in unravelling the process by which islet cells develop naturally in the body. As a result, Dr. Kieffer and his team are aiming to significantly improve upon the manufacturing of the islet cells to obtain more robust insulin delivery, with a focus on generating an optimized process to mass-produce stem cell-derived islet cells that will form the basis for new clinical trials in patients with type 1 diabetes.

Precise Treatment for Pediatric Diabetes: Providing the right care, for the right patient, at the right time, over time

Dr. Shazhan Amed (University of British Columbia) and her team will use this grant to fill the information management gap in pediatric T1D care. TrustSphere will be the ‘one trusted place’ for kids with T1D that brings them, their families, and their healthcare providers together to manage their diabetes information and provide the right care to the right patient at the right time. Patients, families, and their healthcare providers will have access to important diabetes information, like blood sugars and insulin doses streaming from glucose sensors and insulin pumps, or recommendations from the diabetes team – all in one digital tool.

EVERYONE: Empowering diverse youth with diabetes through precision medicine

Dr. Farid Mahmud (The Hospital for Sick Children; SickKids) and his team will examine the impact of diversity (genetics, race, sex, gender, income, family support, mental health, etc.) on diabetes management in youth by applying artificial intelligence approaches. The experiences and barriers faced when receiving diabetes care will be gathered through interviews and feedback from youth with T1D and their families.  Armed with this information, the team will develop individualized treatment strategies that consider patient diversity and conduct a clinical trial to determine the feasibility, acceptability, and appropriateness of the program.

Leveraging biological sex and genetics for beta cell-directed precision medicine in type 1 diabetes

Dr. Elizabeth Rideout (University of British Columbia) investigates the effect of biological sex on metabolic genes and pathways. In this Breakthrough T1D-CIHR grant, her team will apply this work to T1D by examining how beta cell dysfunction differs between biological males and females during the progression of T1D. Rates of T1D are higher in biological males than females, and there is evidence of sex-specific responses to insulin and beta cell functioning in T1D.  Despite this, most T1D studies have used only male animal models and participants, and of those that did use both sexes, most failed to compare data between the sexes.

Spatio-temporal dynamics of immune and non-immune islet injury in type 1 diabetes

Dr. Peter Thompson (University of Manitoba) focuses on the heterogeneity (individual differences) of beta cells within an islet and how individual cells may respond differently to immune system attacks and stressors. T1D varies greatly between individuals in terms of time to onset, rate of progression, and insulin requirements, but the reasons underlying these differences are unknown. This team grant will investigate the functional “hierarchies” that appear to be present amongst beta cells. Specifically, the team will look at “leader” or “hub” beta cells within an islet that are guiding and coordinating the function of the rest of the cells.

Aiming for something sweeter: Supporting youth with T1D during transition from pediatric to adult diabetes care

Dr. Sonia Butalia (University of Calgary) and her team are researching the transition from pediatric to adult diabetes care in people with T1D. Dr. Butalia and her team have previously created a transition intervention that supports teens through texting, emails, phone calls, and social media groups via non-medical transition coordinators. Dr. Butalia will use the Breakthrough T1D-CIHR grant to expand this program to 5 major sites in Alberta and evaluate the impact of the program on participants’ mental health, diabetes management and care transition, and cost effectiveness of the program.

Adaptation and pilot evaluation of a digital intervention targeting the psychosocial needs of individuals with pregestational diabetes

Dr. Deborah Da Costa (McGill University) and her team are experts in maternal mental health and have previously developed a successful digital intervention for pregnant and postpartum women and birthing persons. They will now use the Breakthrough T1D-CIHR grant to collaborate with diabetes experts – primarily those living with T1D and T2D – to adapt their platform for women and birthing persons with pregestational diabetes. The new adaptation – HealthyMoms DM+ – will be evaluated to determine its impact on mental health outcomes in people with pregestational diabetes (i.e., T1D or T2D prior to becoming pregnant) who are planning to become pregnant, are currently pregnant, or are in the 1-year postpartum period.

Type 1 Diabetes, Exercise and Mentoring (TEAM) Trial: Peer mentorship to increase physical activity and quality of life in adolescents with type 1 diabetes

Dr. Jonathan McGavock (University of Manitoba) and his team are focused on improving empowerment, resiliency, and autonomy in adolescents with T1D through physical activity. Dr. McGavock and his team will conduct a 12-week program of group-based exercise led by mentors with T1D that are living healthy, active lifestyles. This program will seek to impart upon the participants a sense of mastery, relatedness and connection with peers, and a sense of autonomy to improve their quality of life through healthy, active lifestyles.

Find Your CommuniT1D: Customized Virtual Peer Support for People Living with Type 1 Diabetes

Dr. Holly Witteman (Université Laval) and her team will create a sustainable peer support program that is led by people with T1D, to improve the mental health and quality of life of people with T1D across Canada. CommuniT1D will be a virtual community led by people with T1D and supported by the research team who bring expertise in mental health, diabetes care, psychology, and social support. This program is intended to continuously adapt to the needs of the community, while the research will focus on the feasibility and acceptability of the program as well as its impact on diabetes distress, quality of life, well-being, diabetes management, and use of resources.

CanScreenT1D led by Dr. Diane Wherrett (The Hospital for Sick Children; SickKids)

This $12 million grant will develop a single nationally coordinated research network to explore key research questions about the feasibility and acceptability of general population screening for early-stage T1D in Canada.

CanScreenT1D is made up of over 30 members including academic and clinician researchers, endocrinologists, people with lived experience of T1D, and knowledge users including a diabetes nurse, genetics counsellor, and a Ministry of Health representative. The acceptability of T1D screening in Indigenous communities will be explored, as led by Sasha Delorme of Diabetes Action Canada’s Indigenous Patient Circle and Indigenous people with lived experience of diabetes.

CanScreenT1D will study different screening approaches, as well as the effectiveness of education and follow-up of people with early-stage T1D. CanScreenT1D will explore how general population screening for early-stage T1D could be carried out in Canadian health care systems, and conduct pilot studies of approaches to inform future implementation across Canada.