Diabetes In High-risk Individuals Research Articles

Prévention du diabète de type 1. Où en sommes-nous? Que dire et proposer aux familles?

Prevention of type 1 diabetes in high risk individuals presents with both positive and negative aspects. On one hand, the availability of reliable and convenient screening tools (antibodies) allows us to quantify the risk of diabetes in the short term. Large randomised studies have provided indisputable answers regarding the efficiency of selection of at risk patients. Unfortunately, both DPT-1 study (using insulin) and ENDIT trial (with nicotinamide) ruined the hopes raised from solid experimental data. These studies have also demonstrated the huge costs in terms of number of subjects, time for follow-up, and financial burden, requiring an international collaboration. Finally, only a small number of such studies can be conducted simultaneously. Progress and obstacles paving this research area must be explained to diabetic patients and their family. Current mitigated results should not drive us to give up screening campaigns. Rather, these results should prompt diabetes centers and families to participate in the selection of high risk individuals in order to explore new therapeutic options within future prevention trials.

Insulin-sensitising agents

Current treatments for non-insulin-dependent diabetes mellitus (NIDDM; Type 2 diabetes) remain far from ideal. The presence of both hyperinsulinaemia and resistance to insulin action challenges the rationale of treatments that primarily boost insulin secretion. Novel therapeutic strategies focus mainly on increasing peripheral sensitivity to endogenous insulin, an approach that has the potential not only to treat but also to prevent Type 2 diabetes in high-risk individuals. Until recently, the most promising new class of agents appeared to be the thiazolidinedione derivatives. These agents are ligands for a specific subtype of peroxisome proliferator activated receptor (PPAR) and decrease plasma glucose levels while reducing circulating insulin and free fatty acid levels. At the time of writing (March 1998), the one approved thiazolidinedione had been withdrawn from the market in the UK after only nine weeks because of cases of hepatic dysfunction and failure occurring in patients in Japan and the USA. It is not yet clear whether this is a class effect and hence whether it will affect other similar agents in development. Reference is made to the current status of other agents in development.

Studies of prediabetes in the spontaneously diabetic BB rat.

It is now well established that human type I diabetes is a chronic autoimmune process characterized by a rather “silent” prediabetic stage of several months to years in duration. (1) An important issue in diabetes research is the identification during the prediabetic period of subjects I at high risk of developing diabetes. Several immunologic and metabolic parameters have been studied to assess their reliability as predictors of 5 future development of diabetes in high risk individuals. Even if the combination of several of these factors proves to be highly specific in I defining the high risk individuals these studies require a lengthy follow-up period to ascertain their sensitivity and reliability in predicting impending diabetes.KeywordsMajor Histocompatibility ComplexBeta CellIslet AllograftAutoimmune Beta CellPrediabetic StageThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.