# Seasonal and Viral Determinants of Type 1 Diabetes Onset, Remission, and Glycemic Control

> **NIH NIH K23** · BOSTON CHILDREN'S HOSPITAL · 2020 · $194,541

## Abstract

PROJECT SUMMARY/ABSTRACT
Glycemic control strongly predicts outcomes in type 1 diabetes (T1D), yet many children with T1D fail to
achieve glycemic targets. This problem is magnified by rising T1D incidence and incomplete understanding of
the etiology of T1D. Winter predominance of T1D onset, worsening of glycemic control, and loss of residual
beta cell function suggest that there may be shared seasonal triggers that contribute to T1D pathogenesis.
Epidemiologic studies using 3-month average glycemic control measures (i.e. glycated hemoglobin) obscure
temporal trends. Investigators of potential viral triggers have examined the role of prespecified viruses, but
have not conducted comprehensive testing for all human viruses. Wide use of continuous glucose monitoring
(CGM) and the availability of systematic tests for all prior viral exposures can now be leveraged to dissect the
causes of T1D and highlight relevant biology for T1D prevention and management.
Dr. Christina Mills Astley, a pediatric endocrinologist and epidemiologist, will approach seasonality of incident
and prevalent T1D using an innovative combination of translational phenotyping, time-series analyses, and
integration of external datasets in her Mentored Patient-Oriented Research Career Development Award. She
now seeks to build on her prior research experiences in infectious diseases modeling and causal inference for
complex data, while acquiring new skills in time-series analysis and bioinformatics, and developing expertise in
T1D pathophysiology, including the role of immune dysregulation, inflammation, and metabolic stress.
Combined with the high-quality mentorship and supportive environment at Boston Children’s Hospital, these
tools will broaden her expertise and enable her to establish an independent research program.
In Aim 1, Dr. Astley will use pediatric T1D CGM data and time-series methods (e.g. change point,
autoregression, temporal clustering) to define seasonal patterns, both acute and chronic, in clinically-relevant
CGM-based glycemic control measures (e.g. coefficient of variation, time in range). In Aim 2, she will quantify
the effect of individual, social, and environmental exposures on these glycemic control measures. Finally, in
Aim 3, Dr. Astley will apply comprehensive antibody profiling (VirScan) to test which viral infection(s) drive T1D
onset, end of remission, and seasonal dysglycemia. Together the results of these investigations will form the
basis of a data-driven approach to understand seasonality in T1D, which in turn may be used to recognize
optimal timing for anticipatory guidance to mitigate the risk of seasonal hyperglycemia and hypoglycemia, and
to identify potential targets for intervention to slow the progression of T1D.
Dr. Astley seeks to become an independent physician-scientist with unique expertise in computational
epidemiology, translational methodologies, and T1D pathogenesis, so as to improve prevention and treatment.
This K23 award will affo...

## Key facts

- **NIH application ID:** 9908075
- **Project number:** 5K23DK120899-02
- **Recipient organization:** BOSTON CHILDREN'S HOSPITAL
- **Principal Investigator:** Christina M. Astley
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $194,541
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9908075

## Citation

> US National Institutes of Health, RePORTER application 9908075, Seasonal and Viral Determinants of Type 1 Diabetes Onset, Remission, and Glycemic Control (5K23DK120899-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9908075. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*