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Type 1 Diabetes Prevention

Several efforts examine the possibility of halting the development of type 1 diabetes. So far the results are mixed -- at best.

TRIGR

The Trial to Reduce Diabetes in the Genetically At-Risk (TRIGR) is based on an intriguing but controversial idea. Both human and animal studies from Finland, which has among the highest rates of type 1 diabetes in the world, suggest that children who are breastfed exclusively from birth and are not exposed to proteins from cow's milk (in either infant formula or regular milk) may have a lower risk for developing type 1 diabetes.

"In studies done both in Toronto and Finland in mice, those mice that were fed the cow-milk protein were more likely to come down with diabetes than those fed a hydrolyzed formula [in which the proteins have been pre-digested and are not detected by the immune system]," says Peggy Franciscus, RN, coordinator for the U.S. arm of the TRIGR trial, based at Children's Hospital of Pittsburgh.

"Based on that and looking at some of the Finnish studies, those children who were weaned early from breastfeeding -- say before 4 months -- and then given a cow-milk protein formula had a higher incidence of type 1 diabetes than those who were either exclusively breastfed past that three-month period, or were put on a formula with pre-digested protein.'

The theory, Franciscus tells WebMD, is that the whole protein is seen by the child's still-developing immune system as foreign, causing it to produce antibodies that attack both the protein and the child's own store of insulin producing beta-islet cells of the pancreas. The theory is supported by data from a small Finnish study that shows children who received cow-milk protein formulas had evidence in the bloodstream of islet-cell autoantibodies, which are thought to be a possible cause of type 1 diabetes.

"The beginning of the story is that people noticed that in Western Samoa, there was no type 1 diabetes. But when those people move to societies that use milk products -- and in Western Samoa until recently they did not -- they begin to get diabetes, and they do get it in Western Samoa now and they do consume milk proteins," explains Dupre, who is a principal investigator for the Canadian branch of the TRIGR study.

Similar observations have been made in the island of Sardinia, where until recently goat's milk but not cow's milk was common in the diet, and in Puerto Rico, where government-sponsored nutrition programs have increased the use of infant formulas based on cow's milk, Dupre tells WebMD.

The final results from the TRIGR study are not expected until about 2007.

DAISY

The DAISY trial (the Diabetes AutoImmune Study in the Young) was designed to answer the question whether certain types of stomach virus (enterovirus) could cause increased susceptibility to diabetes. The study looked at two alternate hypotheses: that enteroviruses are either transmitted from the mother at birth or acquired in early childhood, resulting in a chronic infection that leads to an autoimmune response, or that late infections acquired by children who already have abnormal beta-islet cell function can put the final nail in the coffin of the insulin-secreting cells.

But like the DPT-1 trial, this study yielded negative results. "There is no evidence from this study that enterovirus infection is a risk factor for development of beta-cell autoimmunity," researchers write in the January 2003 issue of the journal Diabetes Research and Clinical Practice.

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