I find this really fascinating because it really points to something I’ve suspected for a while; that it’s possible we may have already found a number of treatments that, in a small subset of people, can improve prognosis or delay onset of T1D – but that not everyone seems to be helped. I sometimes wonder if some combination of genetic and autoantibody testing, plus a number of different therapies that have shown really modest (non-significant) benefits in clinical trials could be combined to have more impact on the health picture.
SAN DIEGO — Close relatives of people with type 1 diabetes who had certain autoantibodies believed to put them at high risk of progression to clinical type 1 diabetes did not benefit from taking oral insulin vs placebo, in a new trial. The participants were mostly children and adolescents, with a median age of 8.
However, “surprisingly,” among a small subset of participants with the same autoantibodies against islet cells but with low insulin secretion, those who received insulin tablets were diagnosed with type 1 diabetes 2.5 years later than those who got placebo.
Thus, although the TrialNet Oral Insulin for Prevention of Diabetes in Relatives at Risk for Type 1 Diabetes Mellitus trial was negative in the “main stratum” of studied patients, “nonetheless this dramatic result in…this subset of patients” is definitely something to follow up with in future research," Carla Greenbaum, MD, from Benaroya Research Institute, in Seattle, Washington, said at the American Diabetes Association (ADA) 2017 Scientific Sessions.
And this is, she stressed, “the largest trial ever performed using oral insulin.”
“Delaying diabetes by a day, by a week, by a month…is so clearly important,” Desmond A Schatz, MD, from University of Florida, Gainesville, emphasized. "We’ve got to define these responders."
The assigned discussant at this session was even more positive. “Is this a negative study? It was perhaps not the home run that we all hoped for, but a prespecified secondary hypothesis was met,” noted David M Maahs, MD, from Stanford University, California.
Moreover, “there were no significant adverse events…I do think it is significant to be able to delay type 1 diabetes for 2.5 years in a subset,” he said, adding, “It’s not perhaps the victory we hoped for, but certainly an incremental advance.”
Unfortunately the Medscape article is subscription only BUT if you do a Google News search you can read it: