When Ryan Moffat began losing weight, complaining of dry mouth and urinating frequently, his mother, Patsy, a nurse, recognized immediately that these were symptoms of diabetes.

It's been five years since his diagnosis, and Ryan, 14, is doing well. His mother, though, casts wary eyes on her other children, Alison, 11, and particularly Adam, 18. Blood tests have shown that Adam has antibodies against insulin-producing cells in his pancreas.His pancreas still makes plenty of insulin but, should that start to change, he may begin taking small amounts of insulin in hope of preventing or at least forestalling the onset of diabetes.

"Living with diabetes is difficult" for Ryan, Moffat said. "He's a teenager; it's difficult to plan activities, meals. ... As a parent, I would want to do anything to prevent that in my other kids."

The Moffats are involved in the Diabetes Prevention Trial, a study sponsored by the National Institutes of Health, to see if insulin infusions and injections can be used to prevent insulin-dependent diabetes. It's a research effort that is not without its critics, including pediatric endocrinologists at Children's Hospital.

The study is not to be confused with the Diabetes Prevention Program, a nationwide effort to determine if non-insulin-dependent diabetes can be prevented.

Non-insulin-dependent diabetes occurs as the body grows resistant to insulin. It is closely associated with aging, obesity and a sedentary lifestyle. The Diabetes Prevention Program is investigating the use of diet, exercise and drugs to prevent the disease in high-risk individuals.

The prevention trial for insulin-dependent diabetics is based on animal studies and a small pilot study at the Joslin Diabetes Center in Boston. Four out of five patients who received low-dose insulin shots in that pilot study did not develop diabetes within five years, compared to seven patients who didn't get the shots and all developed diabetes.

Dr. Dorothy Becker, director of diabetes at Children's Hospital, believes such a trial is premature because diabetes in high-risk individuals can still be predicted with only 60 percent accuracy.

"I don't want to put 40 percent of our kids on insulin who will never develop diabetes," she said. Low blood sugar levels, called hypoglycemia, could occur in these patients, she noted, which can harm children's thinking abilities.

Dr. William Riley, director of pediatric endocrinology at the University of Texas-Houston Medical School, shares those apprehensions and worries that the insulin injections might begin too late to preserve pancreatic function.

"Any therapy that's going to be effective has to be started early, before most of the insulin-producing cells are destroyed," Riley said. One approach is to give high-risk patients vitamin B3, or nicotinamide, which a New Zealand researcher contends can help protect the pancreas.

Riley heads the U.S. arm of a 19-nation study of nicotinamide in diabetes-prone people. It's doubtful that nicotinamide will keep patients from ever developing the disease, but it has few side effects and may delay the onset.

"If we could even hold it off for five years, perhaps until they're past adolescence, the difference would be like night and day," Riley said. "In adolescence, you're almighty and nothing can hurt you."

Diabetic teenagers are thus tempted to ignore the daily blood checks and insulin shots necessary for maintaining good control of blood sugar levels, a key factor in preventing complications.

Nicotinamide might be benign, but it might not be very effective either, said Dr. Alex Gonzalez, medical director of Joslin's satellite clinic at the Western Pennsylvania Hospital.

"It makes sense to me to at least try" low-dose insulin, Gonzalez said, noting that few harmful side effects have been noted in the two-year-old trial. "If I had a child with diabetes (risks), especially one less then 10 or 12 years of age ... I'd try just about anything."

View Comments

That's Moffat's view. When she read about the prevention trial, she wrote to one of the investigators at the University of Washington in Seattle. Adam goes to Children's Hospital here every six months to have his blood analyzed, and samples are sent to Seattle each time.

The Moffats participate in monitoring trials at Children's and understand that doctors like Becker have concerns. Because the trial is a randomized, controlled study, they also know Adam would stand only a 50-50 chance of being assigned to the group of patients that receives insulin, rather than the control group that will not be treated.

"It's kind of scary," she acknowledged. "But we feel we'd be able to at least do something to prevent it."

(Distributed by Scripps Howard News Service.)

Join the Conversation
Looking for comments?
Find comments in their new home! Click the buttons at the top or within the article to view them — or use the button below for quick access.