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