By testing for cytoplasmic islet-cell antibodies (ICAs) along with other biomarkers of type 1 diabetes mellitus, researchers have found that the ability to predict which first-degree relatives are likely to develop type 1 diabetes themselves is greatly improved
The "gold standard" predictive marker for type 1 diabetes, ICA has lost favor with clinicians because of the semiquantitative nature of the test and the subjectivity of its interpretation, Dr. Dorothy J. Becker said during her presentation.
Because they are easier to perform and interpret, radiobinding assays for detecting autoantibodies to glutamic acid decarboxylase (GAD)65, neuroendocrine antigen (IA-2) and insulin autoantibodies have become the preferred screening strategy for identifying individuals at risk.
To see if there is still a role for testing ICAs in at-risk individuals, Dr. Becker and colleagues from the University of Pittsburgh examined a cohort of 1484 first-degree relatives of type 1 diabetes probands treated at Children’s Hospital of Pittsburgh between 1979 and 1984 and followed for up to 22 years. They were tested for all four autoantibodies.
Individuals testing positive for two of the biochemical markers had a 14% risk of developing type 1 diabetes after 10 years. However, among those who were also ICA-positive, the risk was 80% after just 6.7 years.
Identifying risk, Dr. Becker noted, will enable people at risk to enroll in clinical trials of vaccines or other measures to prevent or slow the onset of type 1 diabetes.
One currently underway with which Dr. Becker is involved, the Trial to Reduce Insulin dependent diabetes in the Genetically at Risk (TRIGR), is testing the theory that feeding infants at risk with hydrolyzed formula once they are weaned from breast milk will prevent the disease. Initial studies in diabetic NOD mice have shown that this early intervention significantly postpones disease onset.
"Ideally, the current concept is to screen with the biochemical assays, then if they are positive for even one, the ICA should be measured.”
Anyone interested in participating in the TRIGR trial can find more information at www.TRIGRnorthamerica.org.
Presented at the annual AMA Media Briefing on Diabetes.
People who exercise in middle age are far less likely to develop Alzheimer’s disease and other types of dementia when they are older: Doctors have long realized that regular exercise could prevent and control high blood pressure, diabetes and heart disease. But a few recent studies, including the newest one, have pointed to the more startling finding that exercise can protect against the development of senility, even many years later. In a study published last week, researchers checked for dementia or Alzheimer’s in a group of nearly 1,500 patients 65 and older whose exercise habits have been monitored for nearly 35 years. To the researchers’ surprise, they found that people who engaged in leisure time physical activity at least twice a week as they passed through middle age had a 50 percent lower chance of developing dementia and a 60 percent lower chance of developing Alzheimer’s disease, compared with more sedentary people. "If an individual adopts an active lifestyle in youth and at midlife, this may increase their probability of enjoying both physically and cognitively vital years later in life," said Dr. Miia Kivipelto of the Aging Research Center of Karolinska Institute in Stockholm, Sweden, and the main author of the study. journal Lancet Neurology, Oct 18, 2005
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