What can you tell me about the clinical trials here in New York City treating people who have newly diagnosed type 1 diabetes with medications to affect the t-cells? Is it very hopeful? My son was just diagnosed, and I want to try it, but I am scared for him as far as long-term effects.

I think that you must be referring to a study by Dr Kevan Herold which is evaluating a humanised anti CD-3 monoclonal antibody in children with new onset type�1A (autoimmune) diabetes. It is one of a number of new ventures in this field that have come as a result of the hugely more comprehensive recent understanding of the autoimmune process and of how it might be interrupted. Because there is much evidence that insulin production is permanently and substantially reduced at the time that insulin dependence first appears, little has recently been done for those that have already reached this stage. Indeed, all the earlier attempts to prolong the honeymoon period were unsuccessful. However, this antibody has been shown to produce long term tolerance to autoimmunity in laboratory animals after hyperglycemia has developed. The rationale is that it replaces the destructive Th1 type of lymphocyte response with a protective or Th2 one. The further argument is that any preservation of islet cells, however small, is worth it because it makes for easier control and fewer complications.

Beyond an abstract earlier this year, I have seen no further reports of the progress of this study in five children. These subjects were all within six weeks of diagnosis, and the protocol involved a series of daily intravenous injections over two weeks. There were no significant ill effects. I think though that you or your son’s diabetes doctor needs to contact Dr. Herold directly to decide if you want your son to take part in the larger study and whether he is still eligible. As explained above, most of the new ideas are now being tested in type 1A cases in the prediabetes stage before they require insulin, and I understand that there is a plan for this approach is to do the same.

Since your concern seems to be for the long-term complications of diabetes, you should know that there have been all kinds of recent developments that are making the critical business of exact blood glucose control less of a burden. There are new insulins like lispro and glargine, new essentially painless ways of measuring blood sugar like the FreeStyle meter, and perhaps soon, an insulin that be absorbed from the mouth using a small device rather like an asthma inhaler. A more distant prospect, but still exciting, is the possibility that some very ingenious techniques in genetic engineering can circumvent the autoimmunity.

DOB