Diabetes Week
Publisher: CW Henderson
Issue: July 29, 2002
Page: 3

Prevention
Insulin therapy unsuccessful in delaying or preventing onset of diabetes

2002 JUL 29 - (NewsRx.com) -- by Maria G. Essig, MS, ELS, senior medical writer - The Diabetes Prevention Trial showed that prophylactic insulin therapy designed to prevent or delay the development of diabetes in close relatives of diabetic patients was not successful.

J.S. Skyler and colleagues in the Diabetes Prevention Trial-Type 1 Diabetes Study Group evaluated the ability of insulin to lower the risk of diabetes in blood relatives of diabetic patients. The randomized, controlled, nonblinded trial involved 84,228 first- and second-degree relatives of people with type 1 diabetes, of whom 3152 tested positive for islet-cell antibodies.

A total of 2103 antibody-positive subjects went on to receive testing to establish their risk of diabetes (Effects of insulin in relatives of patients with type 1 diabetes mellitus, New England Journal of Medicine, 2002;346(22):1685-1691B).

Of the 372 patients whose 5-year risk of developing diabetes was greater than 50%, 339 received either low-dose subcutaneous ultralente insulin (0.25 unit/kg/day plus one 4-day insulin infusion/year) or close observation. An oral glucose tolerance test was administered every 6 months during a median follow-up of 3.7 years.

No difference in the number of patients who developed diabetes was found between the observational group (70 patients) and the treated group (69 patients). The annual rate of progression to diabetes was similar between the two groups, 14.6% for the untreated and 15.1% for treated patients. The overall risk of developing diabetes was also comparable (0.96 relative risk). Most patients who went on to develop diabetes did not experience any symptoms.

Patients with impaired glucose tolerance at baseline progressed significantly more quickly to diabetes (22%/year) than did patients with normal glucose tolerance (10%/year, p<0.001).

Study authors concluded that preventive insulin therapy was not effective in preventing diabetes, at least at the doses used in this clinical trial.

The corresponding author for this study is J. S. Skyler, University of Miami, PO Box 016960 (D-110), Miami, FL 33101, USA. E-mail: jskyler~miami.edu.

A search at www.NewsRx.net using the search term "type 1 diabetes" yielded 151 articles in 29 specialized reports.

Key points reported in this study include:

• Long-term insulin treatment in first- and second-degree relatives of type 1 diabetes patients at highest risk of developing diabetes themselves did not affect the incidence of diabetes or rate of progression to diabetes when compared with relatives who did not receive insulin therapy

• Relatives with impaired glucose tolerance at baseline progressed to diabetes at a significantly faster rate than those relatives whose glucose tolerance was normal at baseline

• Diabetes did not cause any symptoms in most of the relatives who developed the disease

This article was prepared by Diabetes Week editors from staff and other reports. Copyright 2002, Diabetes Week via NewsRx.com.