A prospective study of the development of diabetes in relatives of patients with insulin-dependent diabetes
Insulin-dependent diabetes (IDDM) is now known to be an autoimmune disease (in which the body manufactures antibodies against its own proteins), and antibodies to the pancreatic islet cells, which manufacture insulin, have been detected in the blood of most people with IDDM. The relationship between a particular antibody concentration (titer) and the development of the disease, however, has not been ascertained, since considerable variation exists between laboratories in the ways results are expressed. Following the development of an international standard for assays of islet-cell antibody titers, knowledge regarding how these levels change as the disease progresses can be gained. To learn whether these titers can predict the development of IDDM in asymptomatic relatives of people with the disease, 4,015 relatives were followed for several years. The group of relatives comprised 3,413 first-degree and 602 second- and third-degree relatives of 1,590 patients (probands). Probands in whom disease had developed prior to the age of 21 were included in the study. Families with multiplex pedigrees were those in which more than one member had IDDM. The relatives were contacted annually to determine whether they had IDDM, and blood samples were tested every two years, when possible. Results showed that 3.1 percent of the relatives had islet-cell antibodies when first tested, with siblings of probands, relatives younger than 20, and relatives from multiplex pedigrees having a higher frequency of positive tests than nonsiblings, older relatives, and those from simplex pedigrees, respectively. Twenty-one additional relatives had developed antibodies by their second test, but none had IDDM symptoms. Forty relatives, 27 of whom tested positive for islet-cell antibodies and 13 of whom tested negative, ultimately developed IDDM. Relatives with islet-cell antibodies were at higher risk for IDDM, as were those with multiplex pedigrees and those tested the first time before the age of 10. In addition, the antibody titer was a significant predictor of disease; IDDM developed in 47 percent of relatives with a titer above a certain cut-off point. Measurement of the titer of islet-cell antibodies in relatives of people with IDDM can provide important prognostic information about the relatives' risk of developing the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Successful in utero treatment of fetal goiter and hypothyroidism
A case history is presented to illustrate the treatment of a large goiter (enlarged thyroid gland) in a fetus, first detected in an ultrasound examination at 28 weeks' gestation. Such a condition can result in serious complications during labor and at delivery, including the possibility of asphyxia if the goiter obstructs the baby's airway. The mother had Graves' disease (a condition associated with increased levels of thyroid hormone and goiter) and had become pregnant against medical advice. The patient was receiving drug treatment (propylthiouracil) during pregnancy, but the fetal goiter continued to grow. After fetal blood tests revealed that the goiter was the result of hypothyroidism (insufficient thyroid hormone), caused by the mother's thyroid medication, thyroid hormone was injected into the amniotic fluid. This was done weekly for three weeks, and the infant was delivered at 38 weeks' gestation with an only slightly enlarged thyroid. Thyroid studies on the infant were normal, and no complications were noted. A discussion is presented of fetal hypo- and hyperthyroidism, either of which can result from drug treatment of maternal hyperthyroidism. Recent developments in prenatal diagnostic approaches allow sampling of fetal blood from the umbilical cord; if thyroid hormone levels abnormal, treatment should be given directly to the fetus because the placenta does not easily allow these hormones to pass through from the mother's blood. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Cow's milk and insulin-dependent diabetes mellitus: innocent until proven guilty
It may be premature to remove cow's milk from the diets of infants to prevent the development of insulin-dependent diabetes mellitus (IDDM). One research group found antibodies to a protein in cow's milk in the blood of Finnish children who had developed IDDM. The protein has a peptide sequence that resembles part of the pancreatic islet cell that produces insulin. This could explain why the body produces an immune reaction against the islet cells, which leads to IDDM. However, a 1996 study found that children who had islet cell antibodies were no more likely to drink cow's milk than children who did not.
Publication Name: JAMA, The Journal of the American Medical Association
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