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

LIVINGLIVING

continued over

is not proof."

But proving it by doing research was

inevitably going to cost money. Wilkin

remembers, "I was lucky to be introduced

in 2012 to Dick Insell, the Chief Scientific

Officer of the Juvenile Diabetes Research

Foundation (JDRF) in New York. I was

fortunate to get his attention at a time

when JDRF was becoming frustrated

with the pace of progress with progress

in prevention. JDRF had started funding

trials to prevent Type 1 diabetes as far

back as the 1970s, but in 40 years there

was still no cure. Insell said to me, 'we

have to do something different, and the

time to do that is now.'"

The years since have involved gearing

up to set the trial into motion, and that

included Wilkin coming out of retirement

in order to head it up. He says, "The initial

need is to find suitable candidates. They

need to be aged between five and 16,

and to be the offspring of a Type I diabetic

or have a sibling with Type 1 diabetes. The

diabetes needs to have developed in the

relatives before the age of 25. There is a

simple blood-sample screening test. The

chance of anyone being positive for this

test is only 5% but, if it turns out positive,

there is a high chance that the child will

develop type diabetes within five years.

We know we are looking at a very specific

and very small group of people, but we

need to get at least 200 people who fit the

criteria to take part in the trial."

Editor's note: It is not considered ethical

to offer a test for disease risk without a

treatment or trial to follow it up - so the

test is not available to the public.

Not just random

Randomised controlled trials (RTCs)are

the gold standard by which the medical

community test whether its theories

are right or wrong. They are usually

designed to try and demonstrate the

mechanism responsible as well. RCT's

are usually conducted as 'double-blind

trials', where neither the patient nor the

doctor knows if they have been given the

active medication or a placebo. There

need to be two identical (randomized)

groups of similar size, half of whom are

given the active medicine, the other half

placebo. Says Wilkin, "Blinded trials are

the only way to answer certain questions

objectively in medicine, as opposed to

people just giving their opinions, which

are subjective. The conclusions of an RCT

must also be solid statistically."

So what is the Accelerator Hypothesis?

Diabetes, whatever the type, results when

there is insufficient insulin to meet your

needs, and insulin is produced by the

beta cells in your pancreas. At birth, we all

have a large reserve of beta cells, enough

to handle variations in the carbohydrate

we eat. We shouldn't challenge them too

often with high loads of carbohydrate, but

the reserve needs to be there for when

we do. We all lose beta cells naturally over

our lifetimes, but most of us have enough

to get by. Says Wilkin, "Fundamentally,

we are all moving down a slope towards

diabetes and, as we're living longer and

longer, there is predictably more and more

diabetes in the population. In the past,

people died younger, before their beta

cells ran out. Now, diabetes is a much

bigger burden in society. But there is

another issue facing the survival of your

beta cells. The rapid rise in all diabetes

over the past 50 years almost certainly

means that environmental factors are also

at work, and the evidence suggests that

these factors shorten beta cell survival by

reducing the body's sensitivity to insulin

(so-called 'insulin resistance'). The body

responds to insulin resistance by making

more insulin to overcome it, but the extra

demand stresses the beta cells and they

die off quicker."

It's interesting to know that people

TARGET PRACTICE: "The idea that the Accelerator Hypothesis

could be true is what gave it credibility. It fitted in with the

results of many other global trials, but the fit itself is not proof."

Index

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