Infant feeding and type 1 diabetes: new clues

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Researchers in Finland have uncovered a relationship between baby milk formula and the development of antibodies to type 1 diabetes in at-risk children. However, the study was too small, and the connection is so far too unclear, to say that changing babies’ diets might prevent them developing type 1.

The research team studied 230 babies who had been identified as having a genetic risk of type 1 diabetes at birth, by analysis of their cord blood. They all also had at least one family member with type 1.

The babies’ mothers were encouraged to breastfeed as usual, but when breast milk was not available, one group of the babies were given a standard cow’s milk infant formula, and the other group were given a special formula containing casein hydrolysate. This is a milk-derived product in which complex dairy proteins have been reduced to their constituent amino acids.

The babies were given the formula up to the age of eight months, after which both groups were monitored until they were 10 years old. By that time, 4% of children in the intervention group had been diagnosed with type 1 diabetes, compared to 8% in the control group, which is not a statistically significant difference.

However, there were significant differences in the number of children who developed antibodies that are associated with type 1: 16% of the babies who had cow’s milk formula tested positive for at least two of five significant antibodies, compared to 7% of the children who had been given the casein hydrolysate.

Professor Mikael Knip of the Hospital for Children and Adolescents and 
University of Helsinki, who led the study, says: ‘The study showed that the safe 
and simple dietary intervention applied in this pilot trial was capable of 
reducing the emergence of diabetes-predictive autoantibodies by about 50% 
by age 10 in the participants carrying increased disease risk.

‘The current 
study population does not provide sufficient statistical power to 
definitely conclude whether an intervention of this type will reduce the 
frequency of clinical type 1 diabetes, although the preliminary data are 
promising.’

A full-scale trial – TRIGR (Trial to Reduce IDDM in the Genetically at R
isk) – is currently running in 77 study centers 
in 15 countries to provide a conclusive answer to the question of whether 
weaning to a highly hydrolyzed formula will reduce the cumulative 
incidence of clinical type 1 diabetes.  A total of 2,160 children have been 
randomized for TRIGR, and the first results are expected in 2013.

The researchers do not know exactly what the difference is between the 
casein hydrolysate and regular cow’s milk-based formulas; it is thought that a highly hydrolyzed formula might have a beneficial effect on gut microflora.

The full press release from the University of Helsinki can be read here, and an abstract of the paper in the New England Journal of Medicine appears here.

World Diabetes Day: blue light shines on China

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November 14 is World Diabetes Day 2010, and to mark the occasion the International Diabetes Federation (IDF) will launch a major new initiative in China, where 92.4 million people (1 in every 10) have diabetes.

The IDF will be unveiling a major global diabetes plan in Beijing at the iconic Great Hall of the People at Tiananmen Square.  New data on how much diabetes is costing the Chinese economy and society will also be announced, followed by an expert panel session featuring Madame Kong Lingzhi, Deputy Director-General, Chinese Ministry of Health, and Professor Jean Claude Mbanya, IDF President.

‘The Chinese government is demonstrating that they are taking diabetes seriously and recognising its economic impact,’ says the IDF. ‘Now we need governments from the rest of the world to do the same.’

The IDF reports that some progress is being made: on May 13, 2010 the UN General Assembly voted unanimously for UN Resolution 64/265 to hold a UN High Level Summit on Non-Communicable Diseases in September 2011. More information about this can be found at http://www.ncdalliance.org/

World Diabetes Day, the only official World Health Organisation day devoted to a non-communicable disease, has been spreading the message of diabetes awareness, education and prevention since 1991. It is marked by major buildings all over the world being lit up in blue light, and all kinds of fundraising activities with a ‘blue’ theme.

Find out more at: http://www.worlddiabetesday.org

T cell finding builds autoimmunity picture

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Researchers in Canada have identified the role of a type of T cell that might explain more about the automimmune response that can lead to Type 1 diabetes.

The research team found that children newly diagnosed with Type 1 have an increased presence of Th17 cells, a type of T cell discovered in 2005.

‘T cells are white blood cells and key members of the immune system that control infections,’ says Rusung Tan, leader of the team at the University of British Columbia Faculty of Medicine. ‘In healthy individuals, Th17 cells provide a strong defence against bacteria and viruses by guiding the immune system to strongly attack infected targets within our bodies.’

In children susceptible to Type 1 however, it is thought that Th17 might play a harmful role, as this T cell has previously been associated with other autoimmune conditions such as Crohn’s disease.

‘The elevated levels of Th17 cells in type 1 diabetes patients suggest that these cells may also play a key role in the early development of this disease in young patients,’ says Tan.

The findings are published in the October 2010 issue of the Journal of Immunology, and the study was supported by grants from the Canadian Institutes of Health Research and Juvenile Diabetes Research Foundation.

The abstract of the study can be found here.

New project has SWEET Euro vision

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A project to share best practice and improve services for children and teenagers with diabetes right across Europe has been launched by a taskforce of experts from 13 countries, including the UK.

The main aim of the SWEET Project is to set up Centres of Reference to help strengthen the knowledge base about diabetes in young people, to support healthcare professionals by developing pediatric training programmes, and to share information and advice to help to ensure that all young people with diabetes in the EU receive good standards of care.

SWEET’s founders point out that Type 1 diabetes is growing at 3 per cent a year and that a fifth of the world’s 440,000 children with Type 1 live in Europe. Type 2 in young people is also growing rapidly and the SWEET project will address this also.

The SWEET project is due to take three years and is funded by a European body, the Executive Agency for Health and Consumers. A key partner in the UK is Barts and the London NHS Trust.

To find out more, visit the SWEET website here.

Survey: tell Bayer about HbA1c for charity

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Diabetes care company Bayer is asking parents of children with Type 1 for help in an online survey it’s conducting about HbA1c measurement and how it fits into diabetes management routines.

It says the survey will take between 10-15 minutes to fill in, and for every one completed, the company will donate £1 to JDRF (Juvenile Diabetes Research Foundation).

The deadline is 30 November. To complete the survey, visit its website here.

Major research resource launched in Scotland

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A major research project designed to find out more about preventing Type 1 diabetes and its complications has been launched in Scotland.

Up to 10,000 people with Type 1 will be invited to take part in the study, which will take place in diabetes clinics in Aberdeen, Dundee, Dunfermline, Edinburgh, Glasgow, Kirkcaldy and Livingston.  Researchers on the project, known as the Scottish Diabetes Research Network (SDRN) Type 1 Diabetes Bioresource, will collect detailed information from people with type 1 as well as samples of blood, urine and DNA.

So far, studies like this have involved only a few hundred participants, but the scale  of the Scottish project should allow it to set up a data source for researchers that will lay down the foundation for many future diabetes studies worldwide.

The Bioresource is being funded by Diabetes UK and the Chief Scientist Office of the Scottish Government, which are providing more than £675,000.

The project will be supported by Diabetes Research Nurses provided by the Scottish Diabetes Research Network (SDRN), which is also funded by the Scottish Government. The Network is currently establishing a register of people with diabetes who wish to take part in research.  To find out more about the SDRN’s work, visit its website here.

DAISY study offers virus clue to Type 1

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Indications that the presence of an enterovirus may play a part in children developing Type 1 diabetes have been highlighted in two recent studies published in Diabetes, a journal of the American Diabetes Association.

The DAISY (Diabetes and Autoimmunity Study in the Young) project has been running in Denver, Colorado, since 1993, and has followed 2,365 children who were genetically predisposed to islet autoimmunity and Type 1 diabetes.

In a group of 140 children who repeatedly tested positive for islet autoantibodies at an average age of four, 50 progressed to Type 1 diabetes in the next few years. Having tested all the children regularly for signs of enterovirus in their blood, the researchers found that the risk of progressing to Type 1 was significantly increased in those where enterovirus was present.

In a second study conducted by some of the DAISY team in Finland, a group of children with Type 1 diabetes were matched with a similar control group who showed genetic susceptibility but did not have Type 1. In testing for enterovirus in the blood, the study found that positive samples were more frequent in the children who had Type 1 than in those who did not. The risk effect appeared to be stronger in boys than in girls.

The researchers of both studies concluded that enterovirus infection may play a role in the development of Type 1 diabetes in susceptible children.

The connection between viruses and Type 1 diabetes has been the subject of many studies in recent years. JDRF, which has funded research into this area, stresses that having a viral infection does not ‘cause’ a child to develop Type 1. Many factors play a part, but finding out more about how viruses might affect the immune system may help identify more targets for preventing autoimmune conditions like Type 1 diabetes.

To find out more about the DAISY study, visit its website here.

JDRF Launch the One Campaign

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We don’t think people with type 1 diabetes are getting a fair deal so today we’re launching the 1 Campaign to raise awareness of the condition. We want to make decision makers aware of the impact type 1 has on families to improve access to treatments and ultimately secure more money for research into the cure.

Today I’m urging families, children and adults living with type 1 diabetes to shout about the issues and challenges you face on a daily basis. Because the more people involved with the campaign, the more noise we will make. And that means those in power will be more likely to take notice. Find out more about the 1 Campaign and how you can get involved at www.jdrf1campaign.org.uk

Better access to pumps

Insulin pumps have been available for over 20 years, and it is shocking that the UK’s healthcare bodies are not supplying technology that has been proven to improve the health and quality of life of many people with type 1 diabetes. Many European countries have 15-20 per cent of people with type 1 on pumps, and in America this figure is 35 per cent.

Visit www.jdrf1campaign.org.uk

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Insulin pump ‘postcode lottery’ revealed

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Close-up two boys with insulin pumpsAn unfair ‘postcode lottery’ in access to insulin pumps for children and adults with type 1 diabetes has been revealed in a survey of 152 Primary Care Trusts (PCTs) in England.

NICE, the commissioning body, recommends that the standard benchmark rate for the uptake of insulin pump therapy should be 12% of people with type 1 diabetes – or 33% for children under 12 years old. However, the survey found an average provision of only 3.9% across the country, and that this varies widely between PCTs.

Only two trusts – Blackburn with Darwen with 17%, and Halton & St Helens with 13% – exceed the NICE benchmark, while other areas, including Medway in Kent and Croydon in Surrey, have only a handful of patients using pumps.

The survey was conducted by the Medical Technology Group, a coalition of patient groups, research charities and medical device manufacturers, in partnership with INPUT, the insulin pump advocacy group, and Adrian Sanders MP, chair of the All Party Parliamentary Group on diabetes. It was supported by JDRF.

Other notable findings included:

  • Only 5 out of 113 PCTs have a strategy in place to implement NICE guidance on insulin pumps;
  • Just over a third (35%) of PCTs do not use tools and guidance such as NICE’s Commissioning Guide to help deliver adequate insulin pump therapy services;
  • 85.6% of PCTs say that eligible patients are given a choice of using insulin pumps, but this is not borne out by the low number of patients who use them

PCTs that fall below the 12% benchmark uptake rate gave various reasons, ranging from lack to funding to shortage of specialist staff. A number of trusts mentioned lack of enthusiasm among consultants and clinicians, who may be steering patients away from pump therapy. One PCT said it requires all candidates for pumps to attend a DAFNE (carbohydrate-counting) course, and there was a shortage of places.

The authors of the report recommend that all PCTs and other commissioners, such as GP groups, should make use of the ‘How To Why To’ Guide on Insulin Pumps produced by the NHS Technology Adoption Centre, which is designed to save time and improve outcomes by sharing best practice in setting up a pump service.

They also call for better training for clinicians, more information for people with type 1 diabetes and their families about treatment options, and better access to specialist insulin pump centres for patients through the ‘Choose and Book’ system.

John Davis of INPUT says: ‘Access to a treatment as important as insulin pumps should not be dependent on where you live. Insulin pumps have been recommended by NICE because they are an efficient use of the NHS’s resources, and because they can have a dramatic impact on patients’ quality of life and clinical outcomes.

‘The MTG is campaigning to improve patient access to insulin pumps by ensuring that every person with type 1 diabetes who could benefit from an insulin pump – no matter where they live – receives the specialist care they need.’

The survey was widely reported in the regional press; Jacqui Double, mum of Tom and Joseph (pictured, with their pumps) was quoted in the press release and told Kent News of her struggle for funding. Read more here.

To find out more about the How To Why To guide, visit the NTAC website here. It is intended for healthcare professionals but there is a downloadable leaflet and the option to alert your GP to the guide.

New guide brings NHS care to life

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The story of Tom, who was diagnosed with type 1 diabetes at the age of three, is at the heart of an ‘exemplar’ on care for children with type 1 that has been produced by Diabetes UK and the Department of Health.

The 35-page document, which goes into great detail, is designed to bring to life the care pathway for children with type 1 that is set out in the National Service Framework (NSF) for type 1 diabetes in childhood and adolescence.

It describes a number of situations and milestones facing Tom and his family as he grows up, from the shock of initial diagnosis to getting used to new routines. It also covers problems such as Tom breaking his arm and having to go to hospital, being bullied at secondary school, and coping with the transition from pediatric to adult diabetes care.

For each situation, there is an explanation of  the section of the NSF care pathway that is relevant to each stage, and a number of links to further information and support on that particular aspect of care.

Chief author of the exemplar is Libby Dowling, clinical adviser at Diabetes UK, who was supported by input from other health professionals and parents. ‘The exemplar will be invaluable to all involved in the care of children with diabetes, and to parents of children with diabetes and children and young people themselves,’ she says.

The exemplar can be downloaded as a pdf from the Diabetes UK website here.