3 August 2006

Children with diabetes from infancy could face insulin-free future

Patients of a particular genetic type of diabetes could switch insulin for tablets, according to a study led by the Peninsula Medical School, UK. Treatment with sulfonylurea tablets allowed 90% of patients who were diagnosed in their first 6 months of life to stop injecting insulin, and indeed improved their control over the disease.

This landmark international study, funded by the Wellcome Trust, is published today in the New England Journal of Medicine.

The study is good news for around half of patients diagnosed with diabetes before the age of 6 months who have a change in the Kir6.2 gene. Sadly it will not help the much more frequent insulin-treated patients with Type 1 diabetes who will need to continue with their insulin injections.

The switch to sulphonylurea treatment worked for patients aged between 3 months and 36 years and has already been shown to work for up to two years. In all patients who switched to sulphonylureas the blood sugar levels were better. The sulphonylurea tablets work by binding to the same channel that is affected by the genetic change restoring near normal secretion of insulin in response to food.

Professor Andrew Hattersley, of the Peninsula Medical School, Devon, England says: "We found that patients with diabetes caused by Kir6.2 mutations can successfully switch from treatment by insulin injection to oral sulfonylurea therapy. This research shows that genetics really do make a difference - knowing the cause of this diabetes helped us know what type of tablet might work.

"This finding is in contrast to that for most patients with Type 1 diabetes, who need lifelong insulin therapy. But what we want now is to test more people who were diagnosed before they were 6 months old to see if their treatment can be successfully altered".

Dr Ewan Pearson, Clinical Lecturer in the Division of Medicine & Therapeutics at the University of Dundee Medical School, worked on this study as a Wellcome Trust clinical research fellow while at the Peninsula Medical School.

Dr Pearson said, "The striking finding was not just that patients could stop insulin but in every case the overall blood sugar was lower without patients having problems with too low blood sugar. It is rare to find such an excellent response to any treatment."

More than 80 patients have changed their treatment so far as a result of this research. Ann-Marie Davies’ son Matthew was treated with insulin since he was diagnosed with a very high blood sugar at 2 months of age. She noticed marked changes in her baby when he was able to change from insulin injections to tablets. Anne-Marie, from Yeovil in Somerset, says: "It has been a fantastic change and he is so much happier. His blood sugars are so much better and he loves his food."

Patients who were diagnosed with diabetes before 6 months can find out more details about testing for this type of diabetes on the web at: www.diabetesgenes.org

Notes to Editor:

Paper reference: N ENGL J MED 355;5 August 3 2006, 'Switching from Insulin to Oral Sulfonylureas in Patients with Diabetes Due to Kir6.2 Mutations'. Pearson et al

www.NEJM.org

The trial was led by scientists from the UK, France, and Norway, and involved patients from 30 countries.

Professor Andrew Hattersley's team at the Diabetes Genetics Centre was awarded the Queen's Anniversary Prize this year for their pioneering work. Their research is supported by Diabetes UK.

The Peninsula Medical School is a partnership between the Universities of Exeter and Plymouth and the NHS within Devon and Cornwall. The school was established on 1 August 2000. Research is being carried out in the fields of biomedical research, clinical education and health services research; areas which map NHS needs and priorities. Specific enquiries include diabetes, cancer, multiple sclerosis, stroke, the interaction between genes and the environment and better ways of delivering services.

The Wellcome Trust is the most diverse biomedical research charity in the world, spending about £450 million every year both in the UK and internationally to support and promote research that will improve the health of humans and animals. The Trust was established under the will of Sir Henry Wellcome, and is funded from a private endowment, which is managed with long-term stability and growth in mind.

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