There have been several studies on how to prevent type 1 diabetes, but the results are only mixed, even when evaluated in the most optimistic light.
If you are at risk for developing type 1 diabetes because of a family history or other factors, can you take steps to prevent the onset of the disease? The answer is “probably yes.
Causes of type 1 diabetes
Diabetes experts now recognize that type 1 diabetes is an autoimmune disease in which a person’s immune system turns itself on for some reason and begins to attack and destroy the insulin-producing and -producing pancreatic β cells. When the number of destroyed islet β cells is high enough, the body cannot produce enough insulin to regulate blood sugar, leading to type 1 diabetes.
Type 1 Diabetes Prevention Trial
The goal of this study was to see if it was possible to prevent or delay the onset of type 1 diabetes in people at high risk. It is based on the theory that by being exposed to low doses of insulin over a long period of time, the immune system can become “tolerant” to insulin and thus not attack the insulin-producing pancreatic beta cells.
After initial screening, patients were assigned to two trial groups based on their risk of disease (based on family history and genetic profile) for the study.
- Insulin Injection Trial Group (completed). People at high risk of developing type 1 diabetes within 5 years were randomly assigned to either the treatment group or the control group (untreated group). The treatment group received low-dose, long-acting insulin twice daily along with intravenous insulin once a year for 5 days. Unfortunately, this part of the trial proved to be a failure, with 60% of patients in both the treatment and control groups developing type 1 diabetes.
- Oral antigen test. This is the second part of the DPT-1 trial, in which people at intermediate risk for type 1 diabetes (25% to 50% risk) over 5 years were randomly assigned to receive oral insulin or placebo. “The rationale for this trial is completely different from the injection group.” John Dupre, a diabetes expert and professor of medicine at the University of Western Ontario in Ontario, Massachusetts, said, “There is a very plausible theory about the regulation of the immune system by the gut, and there is a lot of data from animal studies to support this theory.” (Editor’s note: This study did not find a difference in the effects of oral insulin versus placebo. However, in subjects with insulin autoantibodies no less than 300 nU/ml, the incidence was significantly lower in the oral insulin group than in the placebo group).
Reducing the Risk of Inherited Diabetes Trial
Human and animal studies from Finland, which has the highest incidence of type 1 diabetes in the world, have shown that children who are exclusively breastfed and never exposed to milk protein (either infant formula or milk) are at lower risk of developing type 1 diabetes.
Animal studies in Toronto and Finland suggest that mice fed milk protein are more likely to develop diabetes than mice fed hydrolyzed formula (in which the protein has been pre-broken down and cannot be detected by the immune system). Some studies in Finland have shown that children who end breastfeeding early (interrupting breastfeeding before the child is 4 years old) and then are fed milk protein formula have a higher risk of developing type 1 diabetes than children who are exclusively breastfed for 3 months or are fed hydrolyzed protein formula.
The theory is that intact protein is seen as foreign by the child’s still developing immune system, causing it to produce antibodies that attack both the protein and the insulin-producing beta cells of the child’s own pancreas. This theory is supported by data from a small Finnish study. The study showed that children who received milk protein formula had autoantibodies to islet cells in their blood, and this antibody was thought to be a possible cause of type 1 diabetes.
The study was initiated after it was noted that no one in Western Samoa had type 1 diabetes. But when Western Samoans entered a society that used milk products, which were not available in Western Samoa until recently, they began to develop diabetes, and when the local population in Western Samoa began to consume milk protein, they also developed diabetes.”
Similar observations were made in Sardinia, where goat’s milk (not cow’s milk) is still very uncommon in the daily diet. In Puerto Rico, the use of cow’s milk protein infant formula was added to a government-funded nutrition program.
Juvenile diabetes autoimmunity study
Aims to assess whether certain types of enteroviruses increase susceptibility to diabetes.
There are two alternative hypotheses for this study: enteroviruses are passed from mother to infant at birth or acquired early in the child’s development, leading to chronic infection that triggers an autoimmune response; or late infection occurs in children with already abnormal islet β-cell function, which gives the insulin-secreting cells the final blow.
This study did not identify enterovirus infection as a risk factor for autoimmune attack on β-cells.
European Niacinamide Diabetes Intervention Trial
To see if high doses of niacinamide, a vitamin B3 with antioxidant properties, can help protect islet β-cell function in people at risk for type 1 diabetes due to family history. The results of the study, presented at the European Diabetes Conference in early 2003, showed that this supplementation did not provide additional diabetes prevention.