PREDICTION AND PREVENTION OF TYPE-I DIABETES-MELLITUS

Type I diabetes mellitus is an autoimmune disease in which a chronic destructive process leads to a selective obliteration of beta-cells and subsequently to insulin deficiency. The disease has a genetic background with a strong association to the human major histocompatability complex (MHC), which - in Caucasians - can be reduced to the absence of aspartic acid (Asp) on the position 57 of the DQ beta-chain. The initiating etiologic factors still remain at large unclear, even though food ingredients and here especially parts of cow milk have been suspected to play part in the pathogenetical process. Autoantibodies against a number of pancreatic antigens have been described and correlated to the disease process, islet cell antibodies (ICA), insulin-antibodies (IAA) and antibodies against a 64 (65) KD islet cell antigen (presumably glutamic acid decarboxylase = GAD) are clinically most established and widely used to screen for persons at risk to develop the disease in the future. In patients at risk, both insulin-secretion and -sensitivity appear to be disturbed. With respect to intervention, oral administration of high dose nicotinamide in the pre-diabetic period - as defined by positive islet cell antibody status - in first degree relatives of Type I diabetic patients appears to be most promising.