The Accelerator Hypothesis, Professor Terry Wilkin, the ADAPT trial, cure for Type 1 diabetes

KITLIVING

T

he autoimmune diabetes

Accelerator Prevention

Trial (adAPT) is a new

clinical trial that aims

to find out whether an

inexpensive drug can prevent Type 1

diabetes in children at risk. It is now

looking for participants, first in Scotland

then in the rest of the UK. The adAPT

trial is a family study. The researchers are

looking for youngsters aged between five

and 16 years with a sibling or parent who

developed T1D before the age of 25 years

of age.

The trial is taking part in Scotland

initially because the further north you go,

the higher the prevalence of diabetes.

Scotland actually has the third highest

incidence of the disease in the world. It

has grown from nine people per 100,000

in 1969 to 39 per 100,000 in 2003, when

the last census was taken. That's just

looking at juvenile diabetes (i.e. children

under 16 years old). So the rise in Type 1

diabetes is just as dramatic as that of Type

2, yet only this type grabs the headlines.

Family connection

The adAPT trial is the brainchild of

Professor Terry Wilkin who says, "That's

a phenomenal increase in diagnoses of

diabetes. It's nearly five-fold -- and just

over the course of a working lifetime."

Wilkin himself graduated from St

Andrews Medical School in 1969. His

interest in diabetes probably goes back

to his mother's Type I diabetes, although

unusually she was diagnosed around

the age of 40, and lived into her mid'80s. Wilkin

says, "She took great care

of herself and was lucky to be a patient

at King's College Hospital in the 1950s

when Robert Lawrence was in charge.

Her diagnosis came after lapsing into a

coma over three days."

Profesor Wilkin graduated

from St Andrew's University

Medical School and received

his MD (commended) on

thyroid autoimmunity from

the University of Dundee. He

was asked out of retirement in

2012 to be chief investigator

of the Accelerator Prevention

Trial (APT), a randomized

controlled intervention trial

designed to test an alternative

to the autoimmunity

hypothesis of Type 1 diabetes.

Terry Wilkin,

University of

Exeter Medical

School, Professor

of endocrinology

and metabolism

continued over

This was a significant experience for

Wilkin, who was nine at the time. He then

spent 10 more years living with diabetes

in his family home before leaving to study

medicine, later becoming a specialist in

endocrinology. His research interests were

in endocrine autoimmunity, specifically

diabetes autoimmunity.

He says, "I noticed that during the

1980s, '90s and the early part of this

century there seemed to be very little

progress in three prevention of Type

1 diabetes, despite an awful lot of

research. Indeed, there have been over

20 well-conducted trials based on the

autoimmunity paradigm, but none have

changed clinical practice. Like many

others, I wanted to know why we were

not yet able to prevent diabetes. Are we

properly understanding the progress of

the disease, or its cause? I wondered

if we were coming at it from the wrong

direction and whether we should reassess

our knowledge base."

After a while, he came up with that

he called his Accelerator Hypothesis, but

recalls that he faced 'a lot of flak' as his

hypothesis challenged the established

model of how type 1 diabetes comes

about. People in the medical community

were used to thinking about diabetes in

a certain way, and were sceptical of his

new proposal. In 2005 he was invited by

the American Diabetes Association to

explain the hypothesis. He remembers,

"There was a very aggressive reaction

at the time, and I think they may have

felt threatened by my questioning of the

status quo. Nonetheless, the idea started

to gain traction from that point on. The

idea that it could be true is what gave it

credibility. It fitted in with the results of

many other global studies, but a fit itself

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