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A population based strategy to prevent insulin-dependent diabetes using nicotinamide
R B Elliott1, C C Pilcher, D M Fergusson
1Department of Paediatrics, University of Auckland, New Zealand.
Insights
Nicotinamide treatment may prevent insulin-dependent diabetes. A trial showed a reduced diabetes incidence in tested children, suggesting a protective effect, though further research is needed to confirm its magnitude.
Area of Science:
- Endocrinology
- Immunology
- Public Health
Background:
- Insulin-dependent diabetes mellitus (IDDM) is a significant health concern.
- Early intervention strategies are being explored to prevent or delay IDDM onset.
- Nicotinamide has been investigated for its potential role in diabetes prevention.
Purpose of the Study:
- To test the hypothesis that nicotinamide treatment can prevent or delay the onset of insulin-dependent diabetes mellitus.
- To evaluate the effectiveness of a population-based diabetes prevention trial using nicotinamide.
Main Methods:
- A population-based trial involving 33,658 school children aged 5-7.9 years in Auckland, New Zealand.
- Children were screened for islet cell antibodies; those positive received nicotinamide treatment.
- Follow-up averaged 7.1 years, with diabetes incidence recorded for tested, treated, and control groups.
Main Results:
- The incidence of diabetes in the tested and treated group was significantly lower than in untested controls (7.14 vs. 16.07 per 100,000 person-years).
- The tested group showed a 41% lower rate of diabetes compared to other groups combined (p = 0.008).
- An 'intention to treat' analysis also suggested a lower incidence in the tested and 'refuser' groups compared to controls (p = 0.12).
Conclusions:
- Nicotinamide demonstrates a protective effect against the development of insulin-dependent diabetes in this trial setting.
- The precise magnitude of this protective effect requires further investigation with longer follow-up periods.
- This study provides evidence supporting nicotinamide as a potential preventative agent for IDDM.
Abstract:
It has been postulated that treatment with nicotinamide may prevent or delay the onset of insulin dependent diabetes mellitus. We report the findings of a population based diabetes prevention trial which tests this hypothesis. 33,658 school children aged 5-7.9 years were randomly selected (by school) from a total population of 81,993 of such children in the Auckland (New Zealand) region. They were offered testing for islet cell antibodies. 20,195 (60%) consented to testing. Of these 185 had islet cell antibodies and met the criteria for treatment with nicotinamide. 173 received this treatment. The study population has an average follow up time of 7.1 years. The diabetes incidence of the untested controls was: 16.07 (12.4-20.5 95% CI) /100,000 person years at risk; in the group who were tested and treated when deemed appropriate: 7.14 (3.1-14.1 95% CI); and in the group offered testing but who did not consent ("refusers'): 18.48 (10.1-31.0 95% CI). The tested group had a rate of diabetes of 41% (20-85 95% CI) of the other groups combined after an age adjustment, which is significant (p = 0.008). The tested group combined with the "refuser' group (i.e. "intention to treat') also has a lower incidence than the control group (p = 0.12). Nicotinamide has a protective effect against the development of insulin dependent diabetes in this setting but the size of the effect has a wide confidence interval. Further follow up may define the magnitude of the protective effect within narrower limits.