Long-Term Outcome of Individuals Treated With Oral Insulin
Diabetes Prevention Trial–Type 1 (DPT-1) oral insulin trial
- Kendra Vehik, PHD1⇓,
- David Cuthbertson, MS1,
- Holly Ruhlig, ARNP, MSN1,
- Desmond A. Schatz, MD2,
- Mark Peakman, MBBS, PHD3,4,
- Jeffrey P. Krischer, PHD1 and
- for the DPT-1 and TrialNet Study Groups
- 1University of South Florida, Pediatrics Epidemiology Center, Tampa, Florida
- 2University of Florida, College of Medicine, Gainesville, Florida
- 3Department of Immunobiology, King’s College London, London, U.K.
- 4National Institutes of Health Research Biomedical Research Centre at Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, U.K.
- Corresponding author: Kendra Vehik, .
OBJECTIVE To evaluate the long-term intervention effects of oral insulin on the development of type 1 diabetes and to assess the rate of progression to type 1 diabetes before and after oral insulin treatment was stopped in the Diabetes Prevention Trial–Type 1 (DPT-1).
RESEARCH DESIGN AND METHODS The follow-up included subjects who participated in the early intervention of oral insulin (1994–2003) to prevent or delay type 1 diabetes. A telephone survey was conducted in 2009 to determine whether diabetes had been diagnosed and, if not, an oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), and autoantibody levels were obtained on all subjects who agreed to participate.
RESULTS Of 372 subjects randomized, 97 developed type 1 diabetes before follow-up; 75% of the remaining 275 subjects were contacted. In the interim, 77 subjects had been diagnosed with type 1 diabetes and 54 of the remainder have had an OGTT; 10 of these were diagnosed with type 1 diabetes, subsequently. Among individuals meeting the original criteria for insulin autoantibodies (IAAs) (≥80 nU/mL), the overall benefit of oral insulin remained significant (P = 0.05). However, the hazard rate in this group increased (from 6.4% [95% CI 4.5–9.1] to 10.0% [7.1–14.1]) after cessation of therapy, which approximated the rate of individuals treated with placebo (10.2% [7.1–14.6]).
CONCLUSIONS Overall, the oral insulin treatment effect in individuals with confirmed IAA ≥80 nU/mL appeared to be maintained with additional follow-up; however, once therapy stopped, the rate of developing diabetes in the oral insulin group increased to a rate similar to that in the placebo group.
- Received March 15, 2011.
- Accepted April 18, 2011.
- © 2011 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.