the ADAPT trial type 1 diabetes prevention


A clinical study is setting out to see if an inexpensive drug can

prevent Type 1 diabetes and is looking for participants. Can

you help?



he autoimmune diabetes

Accelerator Prevention

Trial (adAPT) is led by

Professor Terence Wilkin,

of the University of Exeter

Medical School, with support from

colleagues at the University of Dundee

and NHS Tayside. Initial funding of $1.7

million is being provided by JDRF, the

leading global organisation backing Type

1 diabetes research. The study aims

to contact all 6,400 families in Scotland

affected by the condition, with a view to

expanding into England at a later date.

Children aged 5 to 16 who have a sibling or

parent with Type 1 diabetes will be invited

for a blood test to establish whether they

are at high risk of developing the disease.

If so, they will be invited to take part in

the trial. Researchers will then examine

the impact of administering metformin,

the world's most commonly prescribed

diabetes medicine, to young people in

the high-risk category. If successful, the

large-scale trial could explain why the

incidence of Type 1 diabetes has risen

five-fold in the last 40 years, and provide

a means of preventing it.

Researchers have previously

hypothesised that Type 1 diabetes is

an autoimmune disease caused by a

faulty immune system which attacks and

destroys insulin-producing beta cells in

the pancreas. Clinical trials have tried

drugs that supress the immune system

to attempt to subdue the attack, but the

results have so far been disappointing.

The Accelerator Prevention Trial is the

first to test an alternative explanation for

Type 1 diabetes, and is based on the

accelerator hypothesis, proposed in 2001

by Professor Wilkin.

This hypothesis theorises that

autoimmunity occurs as a response to

damaged beta cells. It believes that beta

cells, stressed by being made to work

too hard in a modern environment, send

out signals that switch on the immune

system. The adAPT trial will test whether

metformin, which is known to protect

the beta cells from stress, can stop the

immune response that goes on to destroy


Professor Wilkin says, "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."

Growing problem

It is estimated that 80,000 children

develop Type 1 diabetes worldwide

each year. There is currently no way of

preventing childhood diabetes in children

and no cure. In the trial, each child will

receive metformin or placebo initially for

four months, during which they will be

tested three times to assess how their

metabolism and immune system respond.

The first stage of the trial will assess

Cale Hutchison, whose dad has diabetes, with his mum, Lynsey.


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