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Ziegler, A.-G. ; Albeer, A.* ; Arnolds, S. ; Assfalg, R. ; Bunk, M. ; Daniel, C. ; Hofelich, A.* ; Jacobsen, S. ; Kick, K. ; Knoop, J. ; Kohls, M. ; Kordonouri, O.* ; Matzke, C. ; Pfirrmann, M.* ; Ramminger, C. ; Sarcletti, K. ; Scholz, M. ; Schütte-Borkovec,K. ; Serr, I. ; Weigelt, M.* ; Weiss, A. ; Winkler, C. ; Bonifacio, E. ; Achenbach, P.

Effect of high-dose oral insulin in children with stage 1 type 1 diabetes: The Fr1da insulin intervention randomized controlled trial.

Diabetes Care:dc252818 (2026)
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OBJECTIVE: Oral administration of an antigen can induce immunological tolerance. Insulin is an autoantigen in childhood type 1 diabetes (T1D). We tested the effect of treatment with high-dose oral insulin on disease progression and immune response to insulin in children with stage 1 T1D. RESEARCH DESIGN AND METHODS: We conducted a phase 2 randomized placebo-controlled double-blind trial in children with stage 1 T1D who received daily oral insulin (7.5 mg/day for 3 months and 67.5 mg/day for 9 months; n = 110) or placebo (n = 110) for 12 months. The coprimary outcomes were 1) time from baseline to dysglycemia or clinical diabetes and 2) increased immune response to insulin within 12 months of treatment (assessed in the first 90 participants). RESULTS: Of 220 participants (n = 112 girls; median age 4.8 years; interquartile range 3.6, 6.2), 179 completed the trial. Dysglycemia or diabetes developed in 87 participants (n = 46 receiving oral insulin and n = 41 receiving placebo; hazard ratio 1.07; 95% CI 0.66-1.73; P = 0.74). The 5-year progression rate was 40% (95% CI 30-51%) in each group. A modest treatment interaction was found with the INS rs689 genotype (P = 0.03). Increased immune response to insulin was observed in 11 (25%) of 44 participants in the oral insulin group and 13 (31%) of 42 in the placebo group (P = 0.63). Oral insulin was well tolerated. No significant study-related adverse events occurred. CONCLUSIONS: In children with stage 1 T1D, 1 year of high-dose oral insulin did not alter progression to dysglycemia or diabetes or immune response to insulin.
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Publication type Article: Journal article
Document type Scientific Article
ISSN (print) / ISBN 0149-5992
e-ISSN 1935-5548
Journal Diabetes Care
Quellenangaben Volume: , Issue: , Pages: , Article Number: dc252818 Supplement: ,
Publisher American Diabetes Association
Publishing Place Alexandria, Va.
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research (IDF)
Research Unit Type 1 Diabetes Immunology (TDI)
Institute of Pancreatic Islet Research (IPI)
Institute of Diabetes and Obesity (IDO)