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Margo Black, R.N., left, and William Russell, M.D., examine Samuel Wittenberg, 19 months old, at the Vanderbilt Eskind Diabetes Clinic as Samuelís mother, Angela, and brother, David, look on. Photo by Susan Urmy

Eskind Clinic joins national diabetes prevention trial network

BY: CAROLE BARTOO

Jacob Wittenberg gets a blood test to look for early signs of type 1 diabetes.
Photo by Susan Urmy

11/17/2006 - Jacob Wittenberg gets a blood test to look for early signs of type 1 diabetes. Photo by Susan Urmy

The Vanderbilt Eskind Pediatric Diabetes Clinic has been selected as one of nine research centers nationwide to begin large-scale studies which could one day lead to the prevention of juvenile (type 1) diabetes.

The clinic was formally named a Major Affiliate site in the National Institutes of Health's Type 1 Diabetes TrialNet Network and is already beginning to enroll families. TrialNet studies seek to hone predictions about who will develop type 1 diabetes and then to test promising treatments to delay or prevent its onset. They will involve both children and adults who are close relatives of individuals with type 1 diabetes of any age.

William Russell, M.D., director of the Eskind Pediatric Diabetes Clinic, is principal investigator of the TrialNet studies at Vanderbilt.

“We know, from a huge study we participated in called the Diabetes Prevention Trial (DPT-1), which wrapped up in 2003, that about 3 percent of the close family members of our patients will actually test at risk for diabetes without having developed it yet,” Russell said. “The 'Natural History' portion of the TrialNet studies will take a close look at who is in that 3 percent, and provide long-term follow-up for those at highest risk.”

This multi-phased approach to taking on diabetes is just now becoming an option, Russell said.

“In the past we didn't advise that parents have testing of other members of the family because there wasn't a reasonable payoff for doing so,” he said “In contrast to type 2 diabetes, where lifestyle changes in the areas of weight loss and exercise are very helpful and can reverse the development of diabetes, there are no effective ways to prevent type 1 diabetes. So knowing you are at risk does you little good until the disease begins to show itself.”

The Vanderbilt Eskind Diabetes Clinic has now begun informing family members of their patients with type I diabetes that they are eligible for the Natural History Study. If families choose to enroll, they will have one tube of blood drawn to test for diabetes auto-antibodies, which are early markers for later development of type I diabetes.

Of that initial group, family members who test positive will be invited to enter phase two of the study, where they get a blood sugar challenge test (oral glucose tolerance test) to determine the degree of risk of developing diabetes.

Those family members who have a greater than 50 percent likelihood of developing type I diabetes in the next five years will be offered long-term follow-up to perhaps catch the onset of diabetes before serious complications occur.

In addition, they will be offered the opportunity to participate in diabetes prevention studies, which will test promising interventions for their ability to delay or prevent the onset of diabetes.

Russell expects to announce a TrialNet diabetes prevention study within the next six months.

Angela Wittenberg jumped at the chance to become one of Vanderbilt's first TrialNet participants. When one of her five sons, David, was diagnosed with type 1 diabetes at age 2, there was no early warning, just rapidly progressing symptoms that signaled it was in full bloom. Now, 10 years later, she says her whole family has been waiting for this kind of opportunity.

“I knew right away I wanted the whole family to participate,” Wittenberg said.

Each of her sons, except the youngest, who is under age 2, decided to sign up for the study and give a vial of blood.

“They know this isn't something that can help David, and it may not even help them directly, but we are all excited it may offer something to the next generation of people who may face type 1 diabetes,” Russell said.

To learn more about Type 1 Diabetes TrialNet, call Margo Black at 936-8638 or toll-free (888) 884-8638 or e-mail: diabetesresearch@vanderbilt.edu.

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