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March 26, 2002

Research: Causes and Prevention

Question from Williamston, Michigan, USA:

Our 10 year old girl has just been diagnosed with early stages of diabetes. She is a DPT-1 participant and was caught early during a routine intravenous GTT. What preventative studies are available to her in this age range?

Answer:

I am not quite sure from your email what stage your daughter reached in the DPT-1 selection. I assume though that she had a positive islet cell antibody screening test and that the IV glucose tolerance test was abnormal. The latter would have excluded her from the oral insulin trial now that the subcutaneous insulin trial has been discontinued.

What is not clear is whether she had full antibody testing and HLA determinations. The results of this latter part would not have affected her eligibility but might have shown whether she had a greater than 50% of developing clinical diabetes in the next five years. You might think to ask the DPT team about this.

As to other preventive studies, quite a number have begun as researchers have been able to dissect the intricacies of the autoimmune process. Some of these involve the use of the newer immunomodualtory drugs for a limited period (MMF or mycophenolate mofutil for example) or immunisation with peptides like the B9-23 insulin moiety. None have reached the point at which justify general application.

In these circumstances, the one study you might ask your daughter’s doctor about was the New Zealand one that showed that insulin dependence could be deferred for as long as eight years in ICA positive children by substantial doses of nicotinamide. The tablets are large and sometimes hard to swallow and there were some other reasons for wondering if the results were quite as convincing as they first seemed. Nonetheless, the vitamin is harmless, and for the time being, it is all that can be offered.

DOB