As many as 3 million people in the United States (roughly 0.9% of the population) and 400,000 in the United Kingdom (roughly 0.6% of the population) have Type 1 diabetes, an autoimmune condition in which the insulin-producing beta cells of the pancreas are destroyed. (Scotland has the third highest rate of the condition in the world.) For reasons that are not yet known, levels of the condition have been increasing in recent years.
Metformin is the most commonly prescribed diabetes medicine in the world, with more than 80 million prescriptions filled in 2015 in the United States alone. It works by decreasing the amount of glucose made by the liver and improving insulin sensitivity in the liver, muscle, and fat cells, thereby protecting the beta cells from stress.
Researchers in Scotland believe that signals of stress sent out by the beta cells are what start the immune system attack — rather than a problem with the immune system, as is commonly believed — which ultimately results in Type 1 diabetes, an idea known as the “accelerator hypothesis.” Relieving the stress on the beta cells, they theorize, might stop this chain of events.
To determine whether taking metformin can delay the onset of the condition in at-risk children, the study team initially plans to contact all 6,400 families in Scotland living with Type 1 diabetes, later extending into England as well. Children who are ages 5–16 with a parent or sibling who have Type 1 will be offered a blood test to see if they are at high risk for developing the condition. Those who are will be invited to participate in the study, known as the “autoimmune diabetes Accelerator Prevention Trial (adAPT),” to see if the medicine can delay or prevent the development of Type 1 diabetes.
“It is possible that a modern environment accelerates the loss of beta cells by overworking and stressing them,” said Terence Wilkin, MD, MBChB, FRCS, researcher and originator of the accelerator hypothesis. “As a consequence, this could be contributing to the rising incidence of Type 1 diabetes, which is appearing in ever-younger age groups. adAPT will use a medication to protect the beta cells from stress, so that they can survive longer.”
Children in the trial will either receive metformin or a placebo (inactive treatment) for the first four months, being tested three times during this time frame to determine the reactions of their metabolisms and immune systems. If metformin is found to lower stress on the beta cells, the children will continue onto the next stages of the trial.
The study, which is initially being funded by JDRF, will take six years to complete.
For more information, read the article “Researchers In Scotland Begin Trial to Prevent Type 1 Daibetes” or visit the adAPT website. And to learn more about metformin, read “Metformin: The Unauthorized Biography,” by diabetes treatment specialist Wil Dubois.
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