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Predigested Formula May Prevent Diabetes in at-Risk Infants

50% Fewer Kids Fed Nutramigen Get Marker of Type 1 Diabetes in Pilot Study

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Phyllis W. Speiser, MD, chief of pediatric endocrinology at Cohen Children's Medical Center of New York and professor of pediatrics at Hofstra University, agrees with Harlan and Lee that it's premature to recommend predigested formula, which costs significantly more than regular formula.

"These formulas are fairly expensive, it would be a very costly thing to undertake," Speiser tells WebMD. "This is not exactly ready for prime time."

The predigested formula used in the Knip study was Nutramigen, from Mead Johnson. The manufacturer provided the formula for the study but was not otherwise involved in funding or directing the study.

A much larger and more tightly controlled study, which will show whether Nutramigen actually can prevent type 1 diabetes, already is under way. Preliminary findings are expected in early 2013, but final results won't be in until 2017.

Type 1 Diabetes Trigger Still Unknown

The diabetes marker that is the focus of the Knip study is the appearance of antibodies to insulin-producing beta cells in the pancreas. When enough of these cells die, diabetes results.

Most experts now think these antibodies are a result, and not the main cause, of an immune response that is killing off beta cells.

There are five of these antibodies, and the appearance of any one is a bad sign. It's not clear exactly how bad, but Knip says that kids who have two or more of these antibodies have about a 90% chance of eventually developing type 1 diabetes.

People with a certain genetic makeup are at increased risk of autoimmune diseases, including diabetes. But only a small percentage of people with this genetic signature get diabetes.

Exactly why children develop type 1 diabetes remains a mystery. Genetic susceptibility plays a major role, but it's not the whole story. A person with an identical twin shares the same genetic makeup, yet if one twin has type diabetes there's only a 50% chance that the other will, too.

Something in the environment is triggering diabetes. What is it? A huge international study -- The Environmental Determinants of Diabetes in the Young or TEDDY study -- is trying to find out.

Study investigators are looking for people willing to enroll their newborns in the 15-year study. Both families with and without diabetes are eligible for the study. More information on the study is available at the ClinicalTrials.gov web site.

The Knip report -- and an editorial by Harlan and Lee -- appear in the Nov. 11 issue of the New England Journal of Medicine.

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