WHAT ARE THERAPIES FOR PREVENTING TYPE 1 DIABETES?

New screening techniques are allowing patients to learn whether they are at high risk for diabetes. Although insulin is the mainstay of type 1 diabetes treatment, research is ongoing to develop other approaches that might, in time, even be curative. The basis for nearly all experimental measures for prevention and treatment of type 1 diabetes is stabilization of beta cells. Preventive measures are sometimes defined as primary and secondary:

• Primary prevention attempts to preserve all beta cells before the disease process starts.

• Secondary prevention hopes to deter further beta cell destruction once it has started and before symptoms arise.

Treatment techniques are those aimed at stabilizing any remaining beta cells at or after diagnosis.

Using Insulin for Prevention of Diabetes

A major trial is underway to determine if early use of insulin will help prevent its progression. Results to date on the use of injected insulin for preventing diabetes have been disappointing. Oral or inhaled insulin is also being investigated.

Vitamins

Vitamin E. High-dose vitamin E is being investigated for its effects on diabetes complications. A 2001 report suggested that vitamin E plus nicotinic acid (niacin) may help delay beta cell loss in newly-diagnosed diabetes. In one study, some patients who took 1,800 IU of vitamin E daily for four months experienced increased blood flow in the retina. Another 2000 study suggested that it may help improve blood flow in young people with type 1, but others indicate it probably does not have much benefit for older people. Protective effects on the kidney do not appear to be significant except in a subset of patients. In any case, large doses (over 1,000 IU a day) are needed for any effect, and it is not known if such doses would produce complications over time. Widespread use is not recommended.

Vitamin D. A Finnish study suggested that vitamin D may be protective against diabetes type 1. In the study, use of vitamin D supplements was associated with an 85% lower risk for diabetes. (Vitamin D can be toxic in high amounts and no one should take supplements without a physician's guidance.)

Immunotherapy

Research is ongoing to develop treatments that use the body's own immune system to impede or prevent beta-cell destruction. One important target for researchers in immunotherapy is the protein glutamic acid decarboxylase (GAD), which attacks beta cells. Investigators are testing vaccines and immune factors, such as antibodies, that are specifically directed against factors believed to trigger the disease process.

Somatostatin Analogues

Somatostatin analogues, such as octreotide and lanreotide, block growth hormones that may play a role in diabetes. They are being studied for their ability to control the release of insulin in the very early stages of diabetes. This inhibition of insulin secretion may allow beta cells to "rest" and preserve residual insulin. Octreotide has other properties as well that may be beneficial in diabetes, such preventing retinopathy.