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 it? The answer is “probably yes.
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 -secreting 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.
Because type 1 diabetes is caused by errors in the normal immune system, researchers believe it is possible to intervene, prevent, interrupt, or at least slow the progression of the disease. So far, however, the results have been mixed at best.
Type 1 diabetes prevention trial
The largest and most ambitious type 1 diabetes prevention study to date is the Diabetes Prevention Trial~type 1 (DPT~1), which began in 1994. The purpose of this study was to verify whether it was possible to prevent or delay the onset of type 1 diabetes in people at high risk. It was based on the theory that by prolonged exposure to low doses of insulin, the immune system could become “tolerant” to insulin and thus not attack the insulin-producing pancreatic β-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 2 daily doses of low-dose long-acting insulin along with 5 days of intravenous insulin once a year. 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 part 2 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,” said John Dupre, a diabetes expert and professor of medicine at the University of Western Ontario in Ontario, Massachusetts, “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 There is a lot of animal data 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 of 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 Hereditary Diabetes Trial
The Trial to Reduce Diabetes in the Genetically At~Risk (TRIGR) is based on an interesting but controversial idea. The highest incidence of type 1 diabetes in the world is in Finland, and human and animal studies from there show that children who are exclusively breastfed and never exposed to milk protein (either infant formula or milk) have a lower risk of developing type 1 diabetes.
Peggy Franciscus, RN, coordinator of the U.S. branch of the TRIGR trial at Children’s Hospital of Pittsburgh, said, “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 is not detected by the immune system). diabetes. Some studies in Finland have shown that children who end breastfeeding early (interrupting breastfeeding before the child is 4 months 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 fed with hydrolyzed protein formula.
Franciscus points out that this theory, supported by data from a small Finnish study, suggests 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 child’s own islet beta cells, which are the insulin-producing cells in the pancreas. The study showed that children receiving cow’s milk protein formula had antibodies to their own islet cells in their blood, and this antibody is thought to be the possible cause of type 1 diabetes.
Dupre, principal investigator of the Canadian subgroup of the TRIGR study, explained, “This study was initiated because 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 people in Western Samoa began to consume milk protein, they also developed diabetes.”
Dupré described similar observations in Sardinia, where goat 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.
(Editor’s note, the TRIGR study results suggest that hydrolyzed protein formula does not reduce the risk of type 1 diabetes compared to regular milk protein formula infant formula.)
Juvenile Diabetes Autoimmunity Study
The Diabetes AutoImmune Study in the Young (DAISY) was designed to assess whether certain types of enteroviruses increase susceptibility to diabetes. The study has two alternative hypotheses: enterovirus is passed from mother to infant at birth or acquired early in the child’s development, resulting in 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.
But, like the DPT~1 study, this study also had negative results. The researchers wrote in the January 2003 issue of Diabetes Research and Clinical Practice, “This study did not find that enterovirus infection was a risk factor for autoimmune attack on beta cells.”
European Nicotinamide Diabetes Intervention Trial
The European Nicotinamide Diabetes Intervention Trial (ENDIT), a study conducted in Europe, Canada, and the United States, was designed to examine whether high doses of nicotinamide, a vitamin with antioxidant properties, 3, could help protect islet β cells. ) helps protect islet beta-cell function, particularly in people at risk for type 1 diabetes due to family history. Dupre described the results of studies presented at the European Diabetes Conference in early 2003 that showed that this supplement did not provide additional diabetes prevention.”