ADJUVANT THERAPY IN RECENT-ONSET TYPE-1 DIABETES AT DIAGNOSIS AND INSULIN REQUIREMENT AFTER 2 YEARS

Partial recovery of beta-cell function in type 1 diabetes is common af ter diagnosis by intensive insulin therapy. Residual beta-cell functio n can be improved by other therapies. Cyclosporin (CyA) and nicotinami de (NA), alone or in combination, can preserve this function, as indic ated by the parameters of metabolic control (insulin dose, HbA1C). Aft er suspension of CyA, insulin requirement returns to control values, s uggesting loss of residual beta-cell function. The effects induced by withdrawal of NA after 1 year are not known. For the first time, we st udied 27 type 1 diabetes patients treated with NA for 12 months and th en followed up for 1 year after discontinuance of NA. Another 25 patie nts treated with NA + CyA and 28 control patients were followed up sim ilarly. Insulin requirement doubled 12 months after discontinuance of NA or NA + CyA, becoming identical to that of controls. As patients sh owed HbA1C values similar to control subjects, it is likely that beta- cell function deteriorated after discontinuance of therapy. As NA is s afer than other agents and its effects are beneficial, longer studies are warranted to investigate NA in prolonged treatments since this com pound is also being considered for prevention of type 1 diabetes.