Oral Insulin Doesn’t Stop Type 1 Diabetes in Those at Risk

Giving close relatives of people with type 1 diabetes oral insulin did not prevent them from developing diabetes, according to data newly published in the November 21, 2017 issue of the Journal of the American Medical Association.

Detailed results of the study, TrialNet Oral Insulin for Prevention of Diabetes in Relatives at Risk for Type 1 Diabetes Mellitus, were first reported at the American Diabetes Association (ADA) meeting in San Diego in June.

The participants were mostly children and adolescents, with a median age of 8, with normal blood glucose but with two or more islet autoantibodies — indicating they would almost certainly develop type 1 diabetes in the future.

They were randomized to 7.5 mg per day of oral insulin (human insulin crystals, Lilly) or placebo, at 87 locations in Canada, the United States, Australia, New Zealand, the United Kingdom, Italy, Sweden, Finland, and Germany, between March 2007 and December 2015. More than half (57.6%) had a sibling with type 1 diabetes.

They had oral glucose-tolerance tests every 6 months to assess if they had developed type 1 diabetes.

During a median follow-up of 2.7 years, among the 389 participants in the main study group, there was no significant difference in diagnosis of type 1 diabetes, with 58 participants in the oral insulin group (28.5%) and 62 taking placebo (33%) developing it.

Time to diabetes development wasn’t different between the two groups (hazard ratio, 0.87; P = 0.21), either.

The study represents the largest-ever trial testing oral insulin, but “these findings do not support oral insulin as used in this study for diabetes prevention,” the study authors state.


da Medscape