Update on Worldwide Efforts to Prevent Type 1 Diabetes

This paper reviews worldwide efforts to interdict the type 1 diabetes (T1D) disease process, during the stage of evolution of the disease prior to the time of disease onset. The goal of intervention before disease onset is to arrest immune destruction and thus prevent or delay clinical disease. In this regard, there have been several large-scale multicenter randomized controlled clinical trials designed to prevent T1D. These have tested nicotinamide, parenteral insulin, oral insulin, nasal insulin, and the elimination of cow's milk from infant feeding

Growth differences between North American and European children at risk for type 1 diabetes

AIM: To evaluate the relationships between early growth and regional variations in type 1 diabetes (T1D) incidence in an international cohort of children with familial and genetic risk for T1D. METHODS: Anthropometric indices between birth to 5 years of age were compared amongst regions and T1D proband in 2160 children participating in the TRIGR study. RESULTS: Children in Northern Europe had the highest weight z-score between birth-12 months of age, while those in Southern Europe and the United States had the lowest weight and length/height z-scores at most time points (P<0.005-P<0.001). Few differences in z-score values for weight, height and BMI were found by maternal T1D status. Using International Obesity Task Force criteria, the obesity rates generally increased with age and at 5 years were highest in males in Northern Europe (6.0%) and in females in Canada (12.8%). However, no statistically significance difference was found by geographic region. In Canada, the obesity rate for female children of mothers with and without T1D differed significantly at 4 and 5 years (6.0 vs. 0.0% and 21.3% vs. 1.9%, respectively; P<0.0125) but no differences by maternal T1D status were found in other regions. CONCLUSIONS: There are regional differences in early childhood growth that are consistent with the higher incidence of T1D in Northern Europe and Canada as compared to Southern Europe. Our prospective study from birth will allow evaluation of relationships between growth and the emerging development of autoimmunity and progression to T1D by region in this at-risk population of children