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October 23, 2003


Question from Garmisch, Germany:

Are there any protocols for sustaining and extending the remission (honeymoon) stage of type 1 diabetes?


Certainly one of the mosts ardently researched themes in type 1 diabetes over the last 20 years have been those of prolonging the honeymoon period in people with clinical diabetes and of averting insulin dependence in those who are just antibody positive. There have been many trials, and the only successful one was with Cyclosporine, but this had to be discontinued because of toxicity to the kidneys.

Protocols continue to be evaluated nonetheless, but at present, I don’t think that any could be classified as recommended and effective. One which may herald further advances as the considerable intricacies of autoimmunity and islet cell regeneration are clarified is the use of anti CD-3 reported in 2002. (See Herold KC, Hagopian W, Auger JA, Poumian-Ruiz E, Taylor L, Donaldson D, Gitelman SE, Harlan DM, Xu D, Zivin RA, Bluestone JA. Anti-CD3 monoclonal antibody in new-onset type 1 diabetes mellitus New England.J.Med 346:1692.2002(May), and there have been claims of success for the use of Heat Shock Protein (DiaPep 277) especially from workers in Israel. Other trials are less discriminant and using some of the newer immunosuppressive drugs like MMF (Micophenolate Mofetil).