Study will target 'triggers' of Type 1 diabetes in children

Eight thousand kids who are at high risk will be followed for 15 years.
SEATTLE TIMES
SEATTLE -- Perhaps it's certain foods they eat or the milk they drink. Maybe an intestinal virus sets off the disease. Even stress from family dynamics is a suspect.
No one knows what sets off Type 1 diabetes in a child genetically at risk for the disease. No one knows why only one in 30 children with a genetic risk actually develops diabetes, which can cause a host of complications and typically shortens lives.
Scientists at the Pacific Northwest Research Institute in Seattle soon will begin trying to identify "triggers" that send young people on the often devastating course of diabetes.
In the largest study ever of environmental influences on juvenile diabetes, the Seattle researchers will join scientists at five medical centers worldwide to follow 8,000 kids at high risk for the disease for 15 years.
"We hope to identify at least a few, and hopefully as many as a dozen, exposures [triggers] that are avoidable," said Dr. Bill Hagopian, principal scientist at PNRI and director of the Seattle portion of the research.
By learning about the triggers, the scientists hope to better predict the disease, prevent or delay it and develop better treatments.
Funding the research
The research is being financed by a $35 million grant from the National Institute of Digestive and Diabetes and Kidney Diseases. PNRI will receive about $1 million a year for the project, called TEDDY, for The Environmental Determinants of Diabetes in the Young. Medical centers in Florida, Georgia, Colorado, Germany, Finland and Sweden also will participate.
Starting this week, the Seattle researchers began asking the parents of area newborns if they could test blood left over from nine disease tests already required by the state at birth. They will screen some 44,000 infants to identify 1,200 babies with a certain genetic marker, HLA-DQ, that puts them at risk for diabetes. Then they will closely monitor the children into their teens, looking for possible triggers.
More than 1 million people nationwide are living with Type 1 diabetes. The disease occurs when the body's immune system attacks the cells that produce insulin, needed to regulate sugar levels.
Over time, diabetes can damage the eyes, heart, kidneys, nervous system and skin, and most people have shortened life spans. Type 2, the most common form of diabetes, usually is diagnosed in adulthood. About $132 billion a year is spent in the United States on treatment and other costs for all forms of the disease, according to the Centers for Disease Control and Prevention.
What will be done
In the TEDDY study, researchers will regularly collect blood and stool samples from the children at risk for the disease. They also will analyze toenail samples from the kids and tap water from the families' homes. Families will provide detailed records, including vaccinations, the presence of pets, possible exposure to pesticides and when the child first consumes certain foods such as cow's milk, infant formula and wheat products. They also will provide information about family dynamics.
"Our purpose is both to test hypotheses and to go fishing," Hagopian said. "We want to look broadly to see what we can find."
Smaller studies have suggested certain intestinal viruses can trigger Type 1 diabetes. Others indicate the risk could increase from consumption of tap water with high nitrate levels; gluten in wheat, barley and oats; and cow's milk, or from too little consumption of vitamin D. Exposure to allergens and stress also may be influences.
As children develop the disease over time, the researchers then can go back and analyze their activities and saved samples. Intestinal viruses, for example, might be found in the stool samples.
The study "is extremely complex," Hagopian said. "It's a gamble, and we don't know what we'll find. It could be that everything will have only a weak effect."
But he said the large number of children in the study will enable researchers to identify influences that increase their risk at least twofold. Those could be great targets for preventing the disease.
"We want to look mainly at prevention," he said. "It's always more useful to act before the horse is out of the barn. It's easier to prevent a disease than to cure it."