Researchers target type 1 diabetes prevention

From the American Medical News, Sept. 27, 2004:

By Victoria Stagg Elliott, AMNews staff

Type 1 diabetes, often viewed as inevitable for those predisposed to it, could one day be as preventable as its well-known relative, type 2.

Such a shift in understanding would be revolutionary. It also would create a need for primary care physicians to take on screening and prevention for type 1 with the same vigor as they currently do for type 2.

For now, though, prevention of type 1 is a proposition of someday, spoken of in terms of "if," not "when." Even so, many experts believe that they now possess important clues that will help them solve the mystery of how to stop it before it starts.

To that end, the National Institute of Diabetes and Digestive and Kidney Diseases in June launched TrialNet, an international network of 18 centers that will study interventions that may prevent development of the disease and improve the prospects for those newly diagnosed with it.

"This will absolutely be in the purview of primary care physicians once we have something that we really think delays or prevents diabetes," said Ellen Leschek, MD, TrialNet's program director. "Even if you're talking about delaying by just two or three years, that's substantial, because every moment that you have diabetes, those are moments that are contributing towards having the long-term effects."

The network is building on the work of the Diabetes Prevention Trial-Type 1, also funded by NIDDK and launched in 1995, which examined the use of low doses of injectable insulin or oral insulin to prevent the development of the disease in those at high risk.

The results, published in the New England Journal of Medicine May 30, 2002, clearly showed that neither intervention worked. In the process, however, researchers learned how to predict who was most likely to progress to type 1 diabetes.

"We can now identify who's at risk for diabetes. It's just a matter of time before we find agents that will actually prevent diabetes," said H. Peter Chase, MD, one of TrialNet's principal investigators and a professor of pediatrics at the University of Colorado Health Sciences Center.

Being able to make this determination allows researchers to target interventions to those who would benefit the most. This testing is also most likely to be the first innovation out of the initial trial and TrialNet to make inroads into clinical practice -- although not just yet.