Podcast Summary
Podcast Title: Taking Control Of Your Diabetes® - The Podcast!
Episode: Unlocking the Mystery of Type 1 Diabetes – The TEDDY & Cascade Studies with Michael Killiam
Date: March 10, 2025
Host: Dr. Steve Edelman
Guest: Michael Killiam, Director of Clinical Services at Pacific Northwest Research Institute
Episode Overview
This episode delves deep into two groundbreaking, long-term studies—TEDDY (The Environmental Determinants of Diabetes in the Young) and the Cascade Study—focused on unraveling both genetic and environmental contributors to the onset of Type 1 Diabetes (T1D). Dr. Steve Edelman and guest Michael Killiam review the history, methodology, discoveries, and future directions stemming from following thousands of children worldwide. Their candid conversation is rich in research insight and personal anecdotes, offering clarity on where the science stands and the hope for prevention and intervention.
Key Discussion Points & Insights
1. Introduction to the Studies and the Guest
- [00:20-03:06]
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Dr. Steve Edelman introduces the episode’s focus and the guest, Michael Killiam, who has dedicated 20 years to T1D research.
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Killiam describes his journey from paramedic to research leader, his excitement for the field, and underscores the collaborative, international scale of TEDDY.
“It’s a huge project with six clinical centers around the world... we've been charged with understanding what environmental factors trigger Type 1 diabetes. And you’re right—it’s brought up more questions than answers, but now we’re asking better questions.”
— Michael Killiam [03:06]
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2. Background, Rationale, and Scope of TEDDY
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[03:06-07:27]
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TEDDY is a 20+ year multicenter project studying children at genetic risk for T1D (from birth to age 15) to identify environmental triggers.
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The goal: tease out which factors—like viruses, diet, or psychosocial stress—distinguish those who develop T1D from those who do not, despite genetic predisposition.
“The vast majority of people...who are genetically predisposed to get type 1...will never get type 1 at all. So there's something in that smaller set that starts the process going.”
— Michael Killiam [05:32]
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The study’s breadth covers frequent biological sampling and detailed data collection.
3. Operational Challenges & Participant Engagement
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[07:27-10:14]
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Maintaining engagement and high retention rates depended heavily on trust and the clinician-family relationship.
“Forming those relationships with the families is really what keeps the families in... Consistently, people praise their clinician. It’s that connection.”
— Michael Killiam [09:31]
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Biological samples collected: blood, urine, stool, nail-clippings, hair, etc.
4. Major Findings: Viruses and T1D Onset
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[10:14-13:30]
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TEDDY confirmed the importance of viral exposure, particularly persistence (not just presence) of infection, in the development of pancreatic autoimmunity.
“It’s not that you get a virus, but it’s how long does that [infection] stay. We saw if you have a viral exposure, and we see it at 60 and 90 days, there’s a definite increase in the autoimmunity.”
— Michael Killiam [12:20]
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The process attacking pancreatic beta cells often starts years before clinical diagnosis.
5. Genetics, The HLA Region, and Screening
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[13:30-16:20]
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Explanation of the HLA (Human Leukocyte Antigen) region: highly influential in immune response and risk for autoimmune diseases.
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TEDDY prioritized children with the highest-risk HLA genotypes, but discoveries highlight more genes are involved—cue Cascade Study.
“Each of these genes weigh a little bit differently, as well as some of them provide protection against others... Understanding that interplay allows us to better provide risk estimates in the future.”
— Michael Killiam [15:10]
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The Cascade Study uses these insights to refine population screening and risk prediction.
6. Cascade Study: Towards Practical Screening & Intervention
- [16:01-17:36]
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Cascade aims to make cost-effective, practical genetic screening and antibody testing part of newborn care.
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Data shows just 3 antibody checks during childhood can optimize detection—compared to many more in TEDDY.
“We better defined the genes that we look at as well as what the antibody schedule is... Narrow it down to really just about three visits.”
— Michael Killiam [17:13]
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7. Environmental Modulators: Vitamin D and Probiotics
- [17:36-19:56], [23:09-26:57]
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Research on dietary factors (Vitamin D, fatty acids): simply supplementing isn’t always effective—genetics mediate benefit.
“It had been shown before, there’s a vitamin D receptor gene... even if you get a lot of vitamin D supplement, your body can only absorb so much.”
— Michael Killiam [18:36] -
Surprising finding: Early-life probiotics linked to lower autoimmunity rates.
“Probiotics in the first month of life... we saw a difference in autoimmunity. These children had a lower incidence.”
— Michael Killiam [25:29] -
Administered via liquid formula, mixed with breast or cow’s milk.
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8. Autoimmune Connections: Celiac & Thyroid Disease
- [23:09-28:39]
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TEDDY followed children for other autoimmune disorders, finding connections in risk timing and presentation.
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Screening should expand to relatives and individuals with other autoimmune disorders, to improve prognosis.
“We know, and we've seen over and over...that the earlier you catch [T1D], the better the outcomes... those improved outcomes last for years after diagnosis.”
— Michael Killiam [27:33]
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9. Evolving Approaches to Screening and Early Intervention
- [28:39-32:15]
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FDA approval of pre-symptomatic T1D therapy (teplizumab) marks a new era, but education for families and providers must improve.
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Cascade Study currently targets newborns in Washington state, aiming to make general newborn screening for T1D a public health reality.
“This project will end with an application to the Board of Health to add Type 1 screening to the newborn panel.”
— Michael Killiam [30:00] -
Economic modeling supports future cost-effectiveness.
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Notable Quotes & Memorable Moments
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“Studying viruses is like stalking ghosts.”
— Dr. Steve Edelman [13:30] -
“The younger you are, the more aggressive the autoimmune process is... we saw kids who would be, you know, antibody negative to antibody positive and then Type 1 in the course of like three months.”
— Michael Killiam [23:57] -
“If you have, if you’re able to screen all of the children and...know who is at risk, then you could change their recommended vaccine schedule and quickly reduce the incidence [of T1D].”
— Michael Killiam [25:17] -
“Screening everyone and then the children that need to have antibody follow-up... what does that look like compared to we don’t do anything and then the children in the hospital and ICU stay for a long time? ...If not there, we are really, really close [to cost effectiveness].”
— Michael Killiam [31:28] -
“Any first degree relative of someone with Type 1 and/or with other autoimmune conditions really should be screened and it’s very easy to get screened these days.”
— Dr. Steve Edelman [32:15]
Timestamps for Key Segments
- 00:20-03:06 Introduction of guest and overview of TEDDY
- 03:06-05:32 Study rationale: genetic risk vs. environmental triggers
- 07:27-10:14 Recruitment, retention, and relationships in long-term studies
- 10:14-13:30 Viruses as triggers—finding on persistence vs. one-time infection
- 13:30-16:20 HLA genetics and expansion to broader risk factors
- 16:20-17:36 Cascade Study: streamlining screening practices
- 17:36-19:56 Environmental modulators (vitamins, nutrition)
- 23:09-26:57 Early-life probiotics and implications
- 27:33-28:39 Celiac, thyroid, and expanding screening recommendations
- 29:28-32:15 Newborn screening, public health policy, and cost modeling
Resources Mentioned
Conclusion
This episode provides a candid, hopeful assessment of how far we’ve come in understanding T1D—especially the interplay of genes, environment, and early interventions. While absolute prevention remains a distant goal, the TEDDY and Cascade studies show incremental, meaningful progress—yielding real benefits in prediction, education, and even delay of the disease. As summed up by Dr. Edelman: “If it’s cost effective, it’s a win win.”