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Aided by relatives of those with type 1 diabetes, TrialNet researchers close in on prevention
Clinical trials have shown that new drugs are able to slow the progression of diabetes in people who have already been diagnosed with the disease. Preventing the disease is the next big step, and according to Kevan Herold, M.D., TrialNet principal investigator and professor of immunobiology and medicine at Yale, "We are attempting to take that step now, and it’s the relatives of those with type 1 diabetes who will make it possible."
Scientists have long known that the autoimmune process that causes type 1 diabetes doesn’t happen overnight, but rather happens over several years. However, a more important recent discovery is that almost all patients with type 1 diabetes have a lengthy pre-diagnosis window that may offer an opportunity to prevent the disease. It is during this critical time that interventional steps can be taken.
Type 1 Diabetes TrialNet is using this important window of opportunity to test prevention strategies. Most recently, TrialNet launched the Anti-CD3 Prevention Study to test whether a drug called teplizumab can prevent or delay type 1 diabetes in high-risk relatives of people with the disease. Teplizumab has been demonstrated to preserve insulin secretion in some people newly diagnosed with type 1 diabetes, and Dr. Herold believes it may actually prevent the disease.
Catherine Price is one of the hundreds of people who have participated in Anti-CD3 studies for newly diagnosed patients. Catherine says, "It’s been 10 years, and I'm still making a measurable amount of insulin, which in the normal course of the disease does not happen."
According to Dr. Herold, virtually all the individuals identified for enrollment in the Anti-CD3 Prevention Study will develop type 1 diabetes. In fact, for those younger than age 18 who are eligible for the study, the risk is more than 75 percent within the next 5 years. "If you are in this group, you are going to develop type 1 diabetes, but now there may be something you can do about it," says Dr. Herold.
TrialNet offers a screening test capable of detecting the autoantibodies that lead to type 1 diabetes up to 10 years before symptoms appear. "No one besides TrialNet has the capability to do a study like this, which requires screening hundreds of thousands of people in pursuit of prevention," explains Dr. Herold. "It’s the most exciting trial I’ve ever done."
"Screening relatives of people with type 1 diabetes to identify their risk is the first step in the pathway to prevention," says Jay Skyler, M.D., Type 1 Diabetes TrialNet study chair and associate director of the Diabetes Research Institute at the University of Miami. "Moving research to the next level requires that relatives of people with type 1 diabetes get screened and get involved in the research." For those with a relative with type 1 diabetes, the chance of developing the disease is 15 times greater than for those with no family history.
According to Dr. Skyler, "The importance of people with or at risk for type 1 diabetes participating in clinical research is enormous. It is through their efforts that we will find a cure for this disease."
There are nearly 200 TrialNet locations nationwide where screening is available at no charge to eligible relatives of people with type 1 diabetes. Screening test kits are also available by mail. To find a TrialNet location or to learn more, visit www.DiabetesTrialNet.org.