Prevention Techniques for Diabetes Mellitus Type 1 and

Prevention Techniques for Diabetes Mellitus: Type 1 and 2 Stephanie Pike Course: PAS 646 Advisor: Dennis Karounos, M. D.

Types of Diabetes: l TYPE 1 DIABETES (T 1 DM) l l l TYPE 2 DIABETES (T 2 DM) l l 5 -10% cases Autoimmune disease Requires insulin Spontaneous? Genetic predisposition 90 -95% cases Insulin resistance and beta cell dysfunction Genetic predisposition- Strong OTHERS

Prevention of T 1 DM: RUBELLA AVOIDANCE l Congenital Rubella Syndrome (CRS) l l Viral infection that correlates with T 1 DM STUDY- Infected rabbits with CR l Result: Changes in rabbit beta cells similar to those in diabetic mice l Direct infection vs. Indirect § § Indirect- Induces an immune response Study- molecular mimicry

Prevention of T 1 DM: RUBELLA AVOIDANCE l Clinically: l MMR vaccine prevents infection! l l Children: 12 -15 mo; again 4 -6 yrs Question women of childbearing age l l l Vaccinate; avoid pregnancy for 28 days Titer: family planning Susceptible pregnant women: vaccinate after delivery before hospital discharge

Prevention of T 1 DM: BREAST MILK VS. COW’S MILK l Breastfeeding- independent protective factor l l l Case controlled dataset T 1 DM decreased as Breastfeeding increased SO… breastfeeding helps protect from T 1 DM l Duration unclear

Prevention of T 1 DM: BREAST MILK VS. COW’S MILK l Parallel effect: Avoiding cow’s milk l l l Bovine insulin-binding antibodies Cross reacting to induce T 1 DM Prospective study 200 infants l l Cow’s milk associated with T 1 DM Clinically: l Breastfeed and avoid cow’s milk for as long as possible up to 12 mo.

Prevention of T 1 DM: HONEYMOON STAGE l Honeymoon stage l l l Continue insulin l l Functional recovery of beta cell function Need for exogenous insulin low Low dose basal insulin Endogenous insulin secretion Better metabolic control After honeymoon stage l l Long honeymoon = Better metabolic control after remission Study 178 diabetic children and adolsecents

Prevention of T 1 DM: ACCELERATOR HYPOTHESIS l Lifestyle factors overlooked in T 1 DM l l l T 2 DM and Obesity l l Autoimmune disease Is this appropriate? Well known correlation Past 35 years… l l l Obesity- doubled T 2 DM- doubled T 1 DM- doubled

Prevention of T 1 DM: ACCELERATOR HYPOTHESIS l Study- retrospective; 94 children in UK l l Overlap of prevention measures l l Greater BMI at diagnosis T 1 DM earlier age Same intense lifestyle changes Don’t believe? l Prevent CV disease!

Prevention of T 1 DM: CLINICAL TRIALS l DPT-1 l Large, multicenter l Insulin as antigen specific immune therapy l Unsuccessful, BUT… § § § l Accurate predictions ID Asymptomatic pts Insulin- does not accelerate disease process More… l Preclinical trials l Successful in mouse model § § Dosing? Metabolically inactive insulin analog

Prevention of T 1 DM: CLINICAL TRIALS l NIH Trialnet l Multi-center, international l l Natural history studies Diabetes prevention studies Diabetes intervention studies Actively recruiting l l l New onset diabetes First degree relatives www. diabetestrailnet. org

Prevention of T 2 DM: LIFESTYLE CHANGES l Definitive data l l l Eating healthy + regular exercise STUDY 3234 overweight, non-diabetic individuals l Placebo l Medication-31% l Intense lifestyle changes– 58% Clinically l NEDP suggests § § § l 30 min physical activity 5 days each week Eating healthier Losing small amt weight THIS IS NOT EASY!!!

Prevention of T 2 DM: STOP SMOKING Insulin Resistance Atherosclerosis Study l 906 subjects § § l Physician’s Health Study § § l Prospective study Smokers- age adjusted relative risk 2: 1 for T 2 DM Pregnant women l l l Current smokers- 25% T 2 DM w/in 5 years Never smokers- 14% T 2 DM w/in 5 years Decreased glucose tolerance Inc risk gestational diabetes Children- Second hand smoke l l 2273 subjects Independently associated with metabolic syndrome

CLINICAL APPLICATION-CONCLUSION: l First or second degree T 1 DM relative l Rubella l l l Vaccinate children with MMR Question and Retest titer in women of childbearing age; Vaccinate women if necessary Breast feed 3 -12 mo. Honeymoon stage- continue insulin therapy Lifestyle changes- diet and exercise Clinical trials l www. diabetestrialnet. org

CLINICAL APPLICATION-CONCLUSION: l T 2 DM in family Hx; sedentary lifestyle; overweight l Intense lifestyle changes l l Exercise 30 min 5 days/week Eat healthier Goal: BMI < 24. 9 Stop smoking l l l No smoking during pregnancy Avoid exposing children to second hand smoke Will also reduce risk of cardiovascular disease

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