CanScreenT1D: Screening Research Consortium in Canada Announced

JDRF Canada, in collaboration with CIHR, is thrilled to announce the recipients of the CIHR-JDRF Type 1 Diabetes Screening Research Consortium. 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. The consortium will build on experiences from other countries with T1D screening programs including the US, UK, Israel, Australia, and multiple European countries. 

Most T1D screening studies have focused only on family members, who are at higher risk of T1D than the general population. However, as 90% of people diagnosed with T1D do not have any family history, family-based screening does not identify most people in the population who go on to develop T1D. This new funding opportunity looks to address this gap and will help to determine approaches for identification of Canadians with early-stage T1D who could benefit from education, monitoring and – in the future – therapies that could delay or even prevent the need for insulin therapy.  As well, it will help advance research into potential disease-modifying therapies that could be applied when an individual is identified as high risk and could delay or prevent the need for insulin therapy. 

JDRF is pleased to announce that Dr. Diane Wherrett (Toronto, ON) will lead CanScreenT1D – the Canada-wide T1D Screening Research Consortium team.

Dr. Wherrett is a physician in the Division of Endocrinology, Department of Paediatrics at The Hospital for Sick Children (SickKids) and a professor at the University of Toronto. She is the Canadian Centre Director for T1D TrialNet (an international research network that screens relatives of people with T1D and leads clinical trials of preventative therapies). The new Canadian consortium 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 team leads are: 

  • Dr. Pranesh Chakraborty, Children’s Hospital of Eastern Ontario (CHEO) 
  • Dr. Robin Hayeems, SickKids 
  • Dr. Monika Kastner, University of Toronto 
  • Dr. Audrey L’Espérance, École Nationale d’administration publique 
  • Dr. Despoina Manousaki, Hôpital Sainte Justine 
  • Dr. Ashish Marwaha, Alberta Children’s Hospital Research Institute 
  • Dr. Jon McGavock, Children’s Hospital Research Institute of Manitoba 
  • Dr. Peter Senior, University of Alberta 
  • Dr. Albert Tsui, University of Alberta 
  • Dr. Bruce Verchere, BC Children’s Hospital Research Institute 
  • Dr. Holly Witteman, Université Laval
  • Conrad Pow, North York General Hospital, Diabetes Action Canada
  • Sasha Delorme, Diabetes Action Canada

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.  

JDRF will work closely with the Screening Research Consortium to ensure that any opportunities for public participation in research consultation or patient engagement are distributed to our community.  The pilot screening program is estimated to start in Fall of 2024.

The Importance of Screening

General population screening offers the potential to identify people who have early-stage, pre-symptomatic T1D. Canada has one of the fastest growing rates of T1D diagnoses anywhere in the world – and we don’t know why.

“Thanks to our team of researchers and patient partners across Canada, we are creating a pilot screening program to help identify children at risk of type 1 diabetes, aligned with the values and preferences of Canadians. With earlier diagnosis and connections with ongoing research initiatives, we can hopefully prevent serious complications at the time of diagnosis and increase access to treatments that may delay or prevent type 1 diabetes”  – Dr. Wherrett

JDRF-funded research previously discovered that the presence of two or more specific markers indicative of an autoimmune response to the pancreas – called autoantibodies – indicates that a person is almost 100% likely to develop T1D in their lifetime. Screening provides the opportunity to educate those with early-stage disease about the signs and symptoms of T1D and provide supportive follow-up, preventing the life-threatening complication diabetic ketoacidosis (DKA) at diagnosis. With the FDA approval of Tzield, the first ever disease-modifying therapy for T1D, for people with early-stage disease, screening offers the opportunity to delay the onset of T1D diagnosis and further research into more disease-modifying therapies.

The prevailing medical wisdom used to be that T1D developed quickly, with a sudden onset of symptoms including thirst, hunger, increased urination, weight loss, and fatigue. Thanks to advances in screening and a better understanding of the human immune system, we now know that T1D does not develop suddenly but in fact the disease process usually starts long before insulin is required.  

Once the immune system begins to attack the insulin-producing cells in the pancreas, we can detect markers in the blood (autoantibodies) that tell us a person is at increased risk. This is because the disease is otherwise asymptomatic or silent earlier on.

T1D happens in 3 stages:

How to Detect T1D in 3 stages

Because most people do not have a family history of T1D, symptoms and a diagnosis often come out of the blue. In 25-45% of diagnoses in children in Canada, this unexpected diagnosis comes with DKA, a serious and life-threatening complication that can lead to death if not treated promptly. An important part of a screening program will be follow-up monitoring for those who screen positive for T1D autoantibodies, to lower the risk for life-threatening DKA at diagnosis and serious complications, and accelerate the evaluation of disease-modifying therapies that could delay or prevent the disease.  

A key goal of JDRF’s global research strategy is to support research that enables introduction of general population screening to identify high-risk individuals for early detection, reduce DKA at diagnosis, and accelerate the evaluation of disease-modifying therapies that could delay or prevent the disease. 

JDRF has numerous research studies examining the efficacy of potential disease-modifying therapies for T1D. But many of these therapies will work best during stage 1 and 2 T1D, which can only be identified via a screening program. Stopping T1D before it starts is the ultimate goal, and a universal screening program will be essential to prevent new diagnoses of this disease in the future.

Current Screening Options in Canada

Currently, only family members of people with T1D can be screened for T1D risk through the TrialNet research program. TrialNet is an international network of leaders in T1D research and clinical care with centers in the United States and internationally. 

We strongly encourage you to consult with your or your child’s physician for input as you make decisions about screening for T1D risk. Considering various sources of expert guidance and that from one’s own physician is the best way to make personal health choices.  

JDRF-CIHR Partnership to Defeat Diabetes Grants Now Announced

The pace of type 1 diabetes (T1D) research is moving faster than ever before. 

In November 2021 to mark November’s National Diabetes Awareness Month, JDRF announced a new investment of $7 million to support four Canadian research teams as part of the JDRF-CIHR Partnership to Defeat Diabetes, which will help to accelerate development of stem cell-based therapies for T1D as well as improve pediatric diabetes research and quality improvement across Canada, and our understanding of variation in human insulin production. 

This is part of the results of the Team Grants in Diabetes Mechanisms and Translational Solutions competition, an investment of $20M in 10 research projects. Diabetes Canada, Kidney Foundation of Canada, and the FRQS have also received funding as part of this competition, as all work together to improve health outcomes for Canadians. 

JDRF is pleased to share the summaries of all four research grants: 

Designing stem cell-derived islets for diabetes therapy

Dr. Timothy Kieffer (University of British Columbia) Nika Shakiba, (University of British Columbia), Dr. Elizabeth Rideout, (University of British Columbia; CIHR Sex and Gender Science), Dr. Corinne Hoesli, (McGill University), Dr. Christopher Moraes (McGill University) 

People with type 1 diabetes lack the islet cells that release the hormone insulin. Scientists at the University of Alberta made breakthrough improvements in transplanting clusters of insulin-producing islet cells. The procedure is quick, and many transplant recipients can reduce or even eliminate insulin injections. Unfortunately, the only current source of islets for transplant is recently deceased donors and only a tiny fraction of those in need can receive the procedure.  

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, it is now possible to replicate many steps of this process in the laboratory with cultured stem cells, culminating in insulin-producing cells. 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. 

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

Dr. James Shapiro, (University of Alberta), Dr. Timothy Kieffer, (University of British Columbia),
Dr. Gregory Korbutt, (University of Alberta), Dr. Patrick MacDonald, (University of Alberta), Dr. Andrew Pepper, (University of Alberta), Dr. Blaire Anderson, (University of Alberta), Dr. Anna Lam, (University of Alberta), Dr. Peter Senior, (University of Alberta), Dr. Khaled Dajani, (University of Alberta) 

In type 1 Diabetes (T1D, ~10%), the B-cells are destroyed by one’s own immune system. In type 2 Diabetes (T2D, ~90%), the body becomes more resistant to insulin, increasing the demand and eventually leading to B-cell damage. Shapiro 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, Nominated Principal Investigator: Canada Research Chair; University of Alberta, along with his team: Dr. James D. Johnson, (University of British Columbia) Dr. Jennifer Bruin, (Carleton University) and Dr. Jianguo (Jeff) Xia, (McGill University). 

Insulin is the primary hormone responsible for controlling blood sugar levels. It is produced by the pancreatic islets of Langerhans, rises after a meal to promote energy storage, and falls during fasting to allow energy mobilization. The levels of insulin in the blood vary tremendously amongst people. Nutrition, age, sex, genetics, and environmental exposures are all important factors likely to impact insulin levels. However, the underlying mechanisms by which these factors affect islet insulin production at the cellular level are not clear.   

This team seeks 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.  

Building CAPACIty for pediatric diabetes research and quality improvement across Canada  

Dr. Shazhan Amed, Nominated Principal Investigator: B.C Children’s Hospital, along with her team: 

Dr. Meranda Nakhla, (Montreal Children’s Hospital; McGill University), Dr. Julia von Oettingen, (Montreal Children’s Hospital; McGill University) and Dr. Ian Zenlea, (Trillium Health Partners; University of Toronto). 

Although there have been many advances in diabetes care since insulin was discovered 100 years ago, youth with diabetes continue to have a higher risk of other health problems, a lower quality of life, and a shorter life span than their peers without diabetes. This health gap is likely in part due to suboptimal access to and delivery of their diabetes care, which is worse in disadvantaged populations across Canada. This project will develop strategies to address these gaps.   

The CAnadian PediAtric diabetes ConsortIum (CAPACIty) is a network of 15 childhood diabetes centers from across Canada. They are partnering with patients/families and health care professionals to jointly design and develop a Canada-wide childhood diabetes registry and research platform. The registry will enable them to improve diabetes care and health outcomes for Canadian youth through comparison of diabetes care quality and outcomes between Canadian diabetes centers, quality improvement initiatives, patient-informed research initiatives across Canada, and successful advocacy work.   

They anticipate that the CAPACIty registry will not only lead to better health outcomes but also serve as a powerful tool for governments and decision-makers to implement policy decisions that are driven by our data. Lastly, the patient advisory board will ensure better representation of youth with diabetes and their parents among provincial and national associations that advocate for people living with diabetes. 

As we celebrate the centenary of the first successful insulin shot in 2022, a groundbreaking achievement that saved millions of lives, we recognize the need to continue investing in research that will move us beyond insulin treatment towards a cure.  

These new grants are an important step in that direction. 

To read more about all the JDRF-CIHR Partnership to Defeat Diabetes: