Study seeks type 1 diabetes breakthrough

Researchers are beginning a huge study that aims to offer a diabetes test to every child in Scotland with a family member who has type 1 diabetes.

Scientists hope the clinical study will confirm a new theory about the cause of the condition.

It could also lead to the first ever preventative treatment.

Scotland has been chosen for the launch of the £1m project because it has the third highest number of type 1 diabetics in the world.

It also has a medical record system which allows researchers to identify affected families.

Type 1 diabetes tends to emerge in childhood and cannot be prevented. Type 2 diabetes usually emerges in adulthood as a result of a poor diet and obesity.

• What is diabetes?

While it is well known that the incidence of diet-related type 2 diabetes is rising, it is less well known that type 1 diabetes is also becoming more common.

The number of people with the condition has risen five-fold in the last 40 years.

Until recently it was widely accepted that type 1 diabetes occurred as the result of malfunction in the body's auto immune system.

Medical science explained that the body attacked insulin-producing cells in the pancreas, leaving it unable to process sugar properly.

However, this research will test an alternative explanation which was put forward in 2001 by Professor Terence Wilkin, of the University of Exeter.

Type 2 diabetes is a result of a poor diet and obesity

At birth, we all have large reserves of beta cells in the pancreas to make insulin which should last a lifetime.

Professor Wilkin's theory is that environmental factors cause these beta cells to be used up more quickly.

For type 2 diabetics, an unhealthy lifestyle is the cause. For type 1 diabetics, Professor Wilkin believes something about the modern environment triggers an immune response.

This "accelerator hypothesis" suggests that the immune system is not the cause of childhood diabetes - it is simply the body's reaction to it, and would explain why the incidence of type 1 diabetes is rising.

Stressed cells

If the Scottish study proves this theory is correct, commonly available drugs could be prescribed to prevent type 1 diabetes for the first time.

The 6,400 households who have a family member with type 1 diabetes will be contacted by Dundee and Exeter universities. Any children between the ages of 5 and 16 will be offered a simple blood test to see if they are at risk.

If the test comes back positive, half of them will be offered a diabetes drug and the other half will be given a placebo. The drug, "metformin", protects beta cells from stress and it is hoped will stop them being destroyed.

"It is possible that a modern environment accelerates the loss of beta cells by overworking and stressing them," said Professor Wilkin.

"As a consequence, this could be contributing to the rising incidence of type 1 diabetes, which is appearing in ever younger age groups.

"This study will use a medication to protect the beta cells from the stress, so that they survive longer.

"If successful, the trial will offer a means of preventing type 1 diabetes with a cost-effective medication, and could be made immediately available to children at risk."