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- December 1, 2008 |
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"Preclinical Diagnosis and Prospects for Prevention of Type 1 Diabetes"Dr. Peter Colman (biography)
English - 2006-04-04 - 36 minutes
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 | (41 slides) |
Summary :
In this presentation Dr. Colman discusses screening for type 1 diabetes as well as completed and ongoing trials designed to prevent type 1 diabetes.
Type 1 diabetes is a polygenetic disease with significant familial clustering. In the natural history of the disease, an autoimmune response is triggered in a proportion of people who are genetically at-risk, and this is followed by a gradual fall in insulin production. The pre-diabetic period for type 1 diabetes can last upto 10 years and so it is of interest to try to prevent the disease.
Studies show that it is possible to predict type 1 diabetes in first-degree relatives. Those with an islet cell antibody concentration of over 20 JDFu for example, are at higher risk for progression to type 1 diabetes. Dr. Colman further talks about the frequency of antibodies to insulin, glutamic acid decarboxylase and IA2 and their role in preclinical diagnosis screening. The loss of first phase insulin production in antibody-positive relatives is another predictor of progression to type 1 diabetes.
A number of trials have looked at altering the immune system in newly diagnosed type 1 diabetics, in an attempt to maintain endogenous insulin production. Different kinds of nonspecific immunosuppression and nonspecific immune stimulation have been tested and were found to have some ability to maintain endogenous insulin production, though these effects were short-lived. In a more recent trial, a humanized monoclonal antibody against CD3 was tested in newly diagnosed patients and found to reduce the decline in c-peptide (1), however some concerns remain.
With regards to preventing progression to type 1 diabetes in antibody-positive relatives, Dr. Colman presents findings from the Diabetes Prevention Trial - Type 1 (DPT-1), the European Nicotinamide Diabetes Prevention Trial (ENDIT) (2) and the Intranasal Insulin Trial (INIT I), and talks about the types of ongoing studies in the field.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The natural history of type 1 diabetes
- Prediction of type 1 diabetes in first-degree relatives
- Results from trials designed to prevent type 1 diabetes: DPT-1, ENDIT and INIT I
- Ongoing studies in the field
Bibliographic references :
1. Kevan C. Herold, M.D., William Hagopian, M.D., Ph.D., Julie A. Auger, B.A., Ena Poumian-Ruiz, B.S., Lesley Taylor, B.A., David Donaldson, M.D., Stephen E. Gitelman, M.D., David M. Harlan, M.D., Danlin Xu, Ph.D., Robert A. Zivin, Ph.D., and Jeffrey A. Bluestone, Ph.D.Anti-CD3 Monoclonal Antibody in New-Onset Type 1 Diabetes MellitusN Engl J Med. 2002 May 30;346(22):1692-8.
2. Prof Edwin AM Gale and European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes The Lancet, Volume 363, Issue 9413, 20 March 2004, Pages 925-93.
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