[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IP] NY Times article about Type 1 prevention trial

Interesting article (found here:
) about administration of insulin by injection or capsules to avoid
development of Type 1 in at-risk individuals. If it works, it won't provide
a cure, but it could dramatically reduce Type 1 incidence.

regards, Andy


Trying to Stop Diabetes Before It Starts

Like thousands of children with Type 1 diabetes, Shannon Meng gets
injections of insulin every day. But unlike them, Shannon does not have
diabetes. In fact, she is perfectly healthy.

Shannon, a 10-year-old from Ramona, Calif., is one of about 600 volunteers,
from age 3 to 45, participating in a diabetes prevention trial, sponsored
by the National Institutes of Health.

Before breakfast and at bedtime, Shannon gets a shot of low-dose insulin in
her arm or her leg.

"Usually my mom or my dad gives it to me, but I learned to do it myself so
I can have sleepovers at my friends' houses," Shannon said. "My friends ask
me if it hurts, but you get pretty used to it when you get two shots a day."

The Mengs enrolled in the trial, called DPT-1, hoping that the daily shots
would prevent Shannon from suffering from this chronic illness that has
stricken her younger sister, Laura.

The decision to enroll was difficult. "We really agonized a lot," said Gina
Meng, Shannon's mother. "To put your child through something like this, you
really want to think you are helping them," she added.

Laura's diabetes was diagnosed when she was 2. "We didn't know anything
about diabetes," Ms. Meng said. "If we could, we would have done anything
to stop it. So that's why we decided to get involved."

There is nothing to prevent or cure Type 1 diabetes. Unlike Type 2
diabetes, which can be associated with obesity, Type 1 diabetes is an
autoimmune disease, which means the body attacks itself. Defense cells that
should target germs and other foreign invaders ravage insulin-producing
cells in the pancreas. In essence, the body mistakes pancreatic cells,
called beta cells, for dangerous toxins.

As insulin supplies dwindle, the body loses its ability to convert food to
fuel. Glucose cannot get into cells, where it is needed, and instead
accumulates, damaging organs.

Doctors may be able to pinpoint those at risk, but they cannot stop the
assault or predict when or if it will occur.

Though people with Type 1 diabetes have to take insulin, the goal of the
study is to give volunteers low-dose shots so they never contract the

"The trouble is that people with diabetes have to take one or two or even
more injections of insulin every day and their blood sugar is still not in
the normal range," said Dr. Francine Kaufman, one of the investigators and
a professor of pediatrics at University of Southern California School of

"We are trying to give two injections to stop the progression of this
process so the person never has abnormal blood sugars and never faces the
short-term or long-term consequences of diabetes," added Dr. Kaufman, who
is also head of pediatric endocrinology at Children's Hospital Los Angeles.

Diabetics are prone to hypoglycemia, dangerously low blood sugar and also
many long-term consequences, like heart disease, nerve damage, kidney
failure and blindness.

The volunteers in the study, from 350 sites in the United States and
Canada, are followed for up to six years. Preliminary results from those
taking insulin shots will be presented at the American Diabetes Association
meeting next month in Philadelphia.

No one knows precisely how the insulin may prevent the illness.

According to one theory, little bits of the insulin  not even enough to
lower blood sugar substantially  will acclimate the body so it no longer
treats the hormone as a foreign invader.

"The studies we are doing now are based on a concept called
antigen-specific therapy," said Dr. Jay Skyler, the chairman of the study
and professor of medicine, pediatrics and psychology at University of
Miami. "If you can identify an antigen involved and you give that antigen,
you may be able to divert the immune system to be protective rather than

Several animal studies and a few small clinical trials support the notion.
For instance, in a study of 12 children, reported in the April 10, 1993,
issue of the medical journal Lancet, only one of five volunteers who got
insulin went on to develop diabetes compared with all seven who did not get
the treatment.

All of the children were considered high risk and they were followed for
two to three years.

In the Lancet study, scientists theorized that somehow the insulin shots
nudged the beta cells to boost their own insulin production. Or perhaps,
the scientists added, the extra insulin allows the beta cells to rest, and
in this peaceful state they escape the immune cell assault.

"My bet is that this study will not be a solution, but will be a step in
the right direction," said Dr. Robert Sherwin, president of the American
Diabetes Association and a professor of medicine at Yale. Dr. Sherwin is
not involved in the study.

All of the volunteers for DPT-1 have a close relative with the illness.
Relatives of diabetics are about 10 to 20 times as likely to get the
disease than the general population.

Type 1 diabetes can strike at any age, but it tends to peak from ages 10 to
13. About 80 percent of the participants are younger than 20, Dr. Skyler

Further blood tests  checking for specific antibodies and assessing sugar
metabolism  categorize volunteers into risk groups, low, moderate or high.
Those who are deemed at low risk are retested every year. Those who are
high risk, like Shannon, are randomly chosen to take insulin shots or they
serve as controls.

Those at moderate risk take one capsule every morning that contains insulin
or a placebo. Evan Oby, 10, from Bismarck, N.D., dissolves his capsule in
juice every morning.

"I guess the first thing we thought was we just wanted the peace of mind,"
said Linda Oby, Evan's mother. Evan's blood results changed during the
second round of testing and he was moved to the moderate risk group. "The
hard part is not knowing whether he is taking placebo or not," Mrs. Oby said.

In addition to taking capsules or getting injections, all of the volunteers
agree to additional blood testing to assess the effectiveness of the
treatment. It is a huge commitment for these children and adults who may
never get the disease.

But for many of them, watching a close relative suffer with Type 1 diabetes
has been a motivating factor. Amanda Newton, a 17-year-old from Sacramento,
was very close to her uncle, who had diabetes and died at 35.

"It's hard to explain to friends why I'm taking capsules," Amanda said. "I
have to clarify and say I'm not diabetic. I'm part of something that may
help prevent diabetes. And that's a really cool feeling."

Copyright 2001 The New York Times Company
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml