Children's Type 1 Diabetes Prevention Trial Beginning

Tim Locke

April 20, 2016

A trial has launched in Scotland to try to prevent type 1 diabetes in children who are at risk of developing the condition.

Around 6,400 families will be contacted and blood tests to screen children for diabetes risks, and preventive treatment may be offered.

Type 1 Diabetes

In type 1 diabetes a person cannot produce insulin themselves and need to take insulin for life to manage their blood sugar levels.

Doctors don't know all the factors that lead to type 1 diabetes, but susceptibility to it can run in families. It is not linked to being overweight or poor diet.

Half of people in the UK with type 1 diabetes are diagnosed under the age of 15.

Scotland has the third highest rate of type 1 diabetes in the world.

Prevention Trial

Type 1 diabetes is seen as an autoimmune disease, meaning the body wrongly attacks part of itself - in this case insulin producing cells in the pancreas.

Some studies have looked at treating the condition by damping down the immune system, but researchers say results have been disappointing.

The new study is based on a variation of the theories on type 1 diabetes, called the 'accelerator hypothesis'.

Some experts think the autoimmunity is linked to beta cells in the pancreas being 'stressed' by having to work hard as a consequence of modern day living.

The first line treatment for type 2 diabetes is metformin. This drug is also known to help protect beta cells from stress. The new trial will look at whether preventing stress in the cells can stop the damaging immune system reaction before type 1 diabetes takes a hold.

adAPT Trial

The accelerator hypothesis was first proposed in 2001 by Professor Terence Wilkin of the University of Exeter Medical School.

He's leading the new study with colleagues and says in a statement: "We still have no means of preventing type 1 diabetes, which, at all ages, results from insufficient insulin. We all lose beta cells over the course of our lives, but most of us have enough for normal function.

"However, if the rate of beta cell loss is accelerated, type 1 diabetes develops, and the faster the loss, the younger the onset of the condition. The accelerator hypothesis talks of fast and slow type 1 diabetes - beta cell loss which progresses at different rates in different people, and appears at different ages as a result."

Children who are identified at being at risk of type 1 diabetes through their family history and testing will be offered metformin or a placebo (dummy) treatment for an initial period of 4 months.

If the medication reduces stress more than the dummy treatment, the 'autoimmune diabetes Accelerator Prevention Trial' (adAPT) will move on to further stages and it is planned to expand it from its Tayside base across Scotland and into England.

Professor Wilkin continues: "It is possible that a modern environment accelerates the loss of beta cells by overworking and stressing them.

"As a consequence, this could be contributing to the rising incidence of type 1 diabetes, which is appearing in ever younger age groups. adAPT will use a medication to protect the beta cells from the stress, so that they survive longer. If successful, the trial will offer a means of preventing type 1 diabetes with a cost-effective medication, and could be made immediately available to children at risk."

He'll be working with Professor Stephen Greene of the University of Dundee and the Tayside Clinical Trials Unit, and who is also director of the Scottish Children’s Research Network (ScotCRN). He adds: "adAPT is an extremely important clinical trial and it is appropriate that ScotCRN, with the Universities of Dundee and Exeter and NHS Scotland are driving forward this exciting project. A simple, safe and effective drug that would prevent the development of type 1 diabetes in young people would be a major breakthrough."

The study is carried out with funding from the type 1 diabetes charity JDRF.


University of Exeter Medical School