Diabetes Mellitus, Type 1 Clinical Trial
Official title:
Oral Insulin for Prevention of Diabetes in Relatives at Risk for Type 1 Diabetes Mellitus
Type 1 diabetes (T1D) is an autoimmune disease. This means that the immune system (the part
of the body which helps fight infections) mistakenly attacks and destroys the cells that
produce insulin (islet cells found in the pancreas). As these cells are destroyed, the body's
ability to produce insulin decreases. There is evidence suggesting that repeated oral
administration of an autoantigen (the same protein that the immune system is reacting to) may
introduce a protective immunity and cause the immune system to stop its attack. An earlier,
large scale study was done to see if oral insulin could delay or prevent the development of
Type 1 diabetes in relatives at risk for developing Type 1 diabetes. The overall results
showed that for the entire study population, oral insulin did not delay or prevent Type 1
diabetes. However, an analysis that was done after the conclusion of the trial suggested a
potential beneficial effect in a subgroup of participants. The participants who seemed to
benefit from oral insulin had higher levels of insulin autoantibodies which are directed
against insulin itself ( called mIAA).
The Type 1 Diabetes TrialNet study group will further explore the potential role of oral
insulin to delay or prevent Type 1 diabetes in a similar group of people. The study will also
include a secondary group of individuals at different levels of risk than those in the
primary cohort to gather information for future studies.
Eligible participants will be randomized to receive either oral insulin (7.5 mg of
recombinant human insulin crystals) or placebo daily.
All participants randomized into this study will be seen at a study site for a follow-up
evaluation, three and six months after randomization, and every six months thereafter.
Participants will be contacted by phone between 6-monthly clinic visits to assess changes in
diabetes status, medication compliance and adverse events. These phone contacts will occur
approximately 3 months from the date of the participants previous clinic visit.
At the study visits, participants will undergo assessments of their insulin production,
immunologic status, and overall health. As the primary outcome measure, subjects will be
followed until development of type 1 diabetes or the conclusion of the study. The trial is
expected to last approximately 7-8 years or until the required amount of information is
gathered.
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