08 May 2012

Diabetes Tests Show Vulnerability Early

Story first appeared in The Wall Street Journal.

There is currently no way to prevent or cure Type 1 diabetes, a disease that has been hitting a growing number of children and adults. So, researchers and public-health officials are pushing more people to get tested to detect the illness early, which can reduce some of its dangerous effects.

As many as three million Americans have Type 1 diabetes, which is an autoimmune disorder that attacks the body's ability to make insulin, a hormone that enables people to get energy from food. Despite the similar sounding names, Type 1 diabetes is very different from the more widespread Type 2 diabetes, which can be controlled and prevented with diet, exercise and medication, and home healthcare medical kits such as the Accu Trend Plus diabetic monitor.

For reasons that aren't clear, cases of Type 1 diabetes, long called juvenile diabetes because it is often diagnosed in young people, have been growing at an annual rate of about 3%. About 30,000 new cases are diagnosed each year—about half of them in adults.

A blood test can help doctors identify the onset of the disease as many as 10 years before symptoms start. Early detection can help patients avoid unknowingly slipping into a critical insulin deficiency, which can be fatal; for many people, a visit to the emergency room offers the first inkling they have the disease. And starting treatment for Type 1 early can guard against long-term dangers including kidney failure, blindness and other complications.

Type 1 Diabetes TrialNet, a network of 18 research centers conducting clinical trials, is expanding a nationwide free screening program. Tests are being offered to family members of people with Type 1 diabetes, who studies have shown have a 15 times greater risk of developing the condition than the general population. The consortium also hopes information gathered from patients will further its efforts to prevent or cure the disease.

There is a real advantage to finding out your risk status. There is evidence that people who get screened and find out they are at high risk are less likely to be presented with a severe crisis that is out of control and can be fatal.

The screening program also helps TrialNet recruit volunteers for its research. In one study, for example, researchers are testing whether one insulin capsule a day can prevent or delay the onset of Type 1 diabetes in certain patients.

In Type 1 diabetes, the body's immune system mistakenly destroys insulin-producing cells in the pancreas, causing sugar to build up in the bloodstream where it can cause life-threatening complications. Signs and symptoms of the disease can emerge fast, and include increased thirst, extreme hunger, frequent urination, weight loss, fatigue and blurred vision. People with Type 1 diabetes require lifelong insulin injections.

While the exact cause of Type 1 diabetes isn't known, researchers are finding that a combination of hereditary and environmental factors can trigger it, including about 50 genes linked to the disease. In one study in the U.S. and Europe, half a million newborns have been screened for genetic risk, and more than 8,000 children at the highest risk are being followed to determine if diet and exposure to infectious agents like viruses could be a factor in its development. For reasons that aren't clear, the disease is increasing at its fastest rate in children under age 5.

The more genes one shares with other family members who have been diagnosed, the higher the risk. Screening tests are being offered to anyone 45 years old or younger with a sibling, parent or child with the disease. People 20 years old or younger with a cousin, aunt, uncle, niece, nephew, half-sibling or grandparent with the disease also are being encouraged to get screened. The program offers to send kits to people who aren't near a testing site to bring to their doctor or a local lab.

Screenings test the blood for certain antibodies that signal an increased risk for Type 1 diabetes. People who test positive are asked to join a monitoring study that estimates the level of risk for developing the disease. Patients at highest risk are followed up twice a year for blood tests and oral glucose-tolerance tests, which measure blood sugar after a patient drinks a sugar-containing beverage.

TrialNet, which so far has about 200 screening sites at medical centers, doctor's offices and other locations, has so far tested more than 100,000 people, according to its chairman. About 5% of those tested have had one or more of the antibodies that signal an increased risk for developing Type 1 diabetes.

Some people wrongly assume that Type 1 diabetes only affects young people. A 42-year-old maintenance technician in Athens, Ga., was screened last year through the TrialNet program at a JDRF fundraising walk. Two of his three siblings have the disease, and his 15-year-old son was diagnosed at age 10. He tested positive for the antibodies that signal an increased risk and is now participating in the monitoring program. He says it never occurred to him that he might be at risk because he hadn't developed the disease at this point in his life.

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