CClinicalTrials.gg
CompletedNCT00570102MIPUpdated Nov 28, 2012

Nutritional Prevention Pilot Trial for Type 1 Diabetes

A Phase 2 interventional study of A highly hydrolyzed formula and A regular cow's milk based formula in Type 1 Diabetes Mellitus, sponsored by University of Helsinki. Completed at 18 sites in Finland. Open to participants aged 1 Day to 7 Days, including healthy volunteers. Per ClinicalTrials.gov, last updated 2012-11-28.

Sponsored by University of Helsinki · Phase 2, Interventional, and Prevention

Phase
Phase 2
Study type
Interventional
Enrollment
230
Allocation
Randomized
Ages
1 Day to 7 Days
Sex
All
01

Study summary

The overall objective of the study is to assess whether complete avoidance of cow's milk (CM) proteins, for at least the first 6 months of life, prevents type 1 diabetes (insulin-dependent diabetes mellitus, IDDM) in genetically susceptible children who have a mother, biological father or sibling affected by type 1 diabetes.

Read the detailed description

Among the environmental factors leading to type 1 diabetes in childhood, the most important are certain viral infections and possibly some dietary factors. Among the latter cow's milk proteins are of special interest. They have been shown to be involved in the pancreatic beta-cell lesion in animal experiments. In humans there are some indications of a role of early exposure to cow's milk proteins as a risk factor for later type 1 diabetes. The hypothesis has not been confirmed, but a randomized, controlled double-blinded intervention trial should provide a definite answer.

This study aims at assessing whether one can decrease the future incidence of beta-cell autoimmunity and/or type 1 diabetes in children who have an increased genetic risk for the disease, by administering in infancy after breast feeding until the age of 6-8 months such a formula, in which the cow's milk proteins have been hydrolyzed to smaller peptides. The children in the control group, carrying a similar increased genetic risk, will receive a conventional cow's milk based formula .

This project is a pilot multicenter trial comprising 15 hospitals in Finland.

02

Conditions studied

  • Type 1 Diabetes Mellitus

Keywords

  • dietary manipulation
  • infants
  • feasibility
  • Type 1 Diabetes Mellitus, Beta-cell Autoimmunity
03

In context

Diabetes Mellitus

10,925 studies on the registry are indexed under Diabetes Mellitus; 1,319 are open to participants now.

This study's enrollment of 230 is above the median of 80 across 8,367 interventional studies indexed under Diabetes Mellitus.

Browse Diabetes Mellitus studies →

Lead sponsor

University of Helsinki is the lead sponsor of 129 studies on the registry; 19 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
1 Day to 7 Days
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • the participant must have a mother, biological father or sibling with type 1 diabetes
  • the participant must carry a susceptible HLA genotype(HLA-DQB1*02 and/or DQB1*0302 without protective alleles (DQB1*0301, *0602 and *0603)

Exclusion criteria

Exclusion Criteria:

  • no telephone
  • no accessibility to any of the research centers
  • inability of parents to understand the study and instructions
  • unwillingness/inability to feed the infant CM-containing food for any reason (e.g. religious, cultural reasons)
  • gestational age less than 36 weeks
  • Any severe illness such as chromosomal abnormalities, congenital malformations, respiratory failure, enzyme deficiencies of the newborn.
  • the newborn infant has received any cow's milk-based product prior to randomization
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Study design

Phase
Phase 2
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
230 participants (actual)

Study arms

  • Active comparator
    A highly hydrolyzed casein formula

    Dietary Supplement: A highly hydrolyzed formula

  • Placebo comparator
    A conventiona cow's milk based formula

    Dietary Supplement: A regular cow's milk based formula

Interventions

  • Dietary supplementA highly hydrolyzed formula

    Weaning to a highly hydrolyzed formula, avoidance of all supplemental food containing cow's milk proteins and/or bovine serum albumin up to the age of 6-8 months

  • Dietary supplementA regular cow's milk based formula

    Weaning to a regular cow's milk based formula supplemented with 20% of the highly hydrolyzed formula used in arm 1 to make the study formulas similar in smell and taste, avoidance of all supplemental food containing cow's milk proteins and/or bovine serum albumin

06

What researchers measure

Primary outcomes

  1. Positivity for two or more diabetes-associated autoantibodies and/or clinical type 1 diabetes

    Time frame: 10 years

07

Study locations

18 sites
  • Jorvi Hospital
    Espoo, 02740, Finland
  • University of Helsinki, Department of Obstetrics and Gynecology
    Helsinki, 00290, Finland
  • National Public Health Institute
    Helsinki, 00300, Finland
  • Helsinki University Hospital, Maternity Hospital
    Helsinki, 00610, Finland
  • University of Helsinki, Hospital for Children and Adolescents
    Helsinki, FIN-00290, Finland
  • Kanta-Häme Central Hospital, Department of Pediatrics
    Hämeenlinna, 13530, Finland
  • North Karelia Central Hospital
    Joensuu, 80210, Finland
  • Central Finland Central Hospital
    Jyväskylä, 40620, Finland
  • Kymenlaakso Central Hospital, Department of Pediatrics
    Kotka, 48210, Finland
  • University of Kuopio, Department of Pediatrics
    Kuopio, 70210, Finland
  • Päijät-Häme Central Hospital
    Lahti, 15850, Finland
  • South Karelia Central Hospital
    Lappeenranta, 53130, Finland
  • University of Oulu, Department of Pediatrics
    Oulu, 90014, Finland
  • Satakunta Central Hospital
    Pori, 28500, Finland
  • South Ostrobothnia Central Hospital
    Seinäjoki, 60220, Finland
  • Tampere University Hospital, Department of Pediatrics
    Tampere, 33520, Finland
  • University of Turku, Department of Virology
    Turku, 20520, Finland
  • Vaasa Central Hospital
    Vaasa, 65130, Finland
08

References and documents

Publications

  • Akerblom HK, Savilahti E, Saukkonen TT, Paganus A, Virtanen SM, Teramo K, Knip M, Ilonen J, Reijonen H, Karjalainen J, et al. The case for elimination of cow's milk in early infancy in the prevention of type 1 diabetes: the Finnish experience. Diabetes Metab Rev. 1993 Dec;9(4):269-78. doi: 10.1002/dmr.5610090407. No abstract available. PubMed 7924824 ↗
  • Akerblom HK, Knip M. Putative environmental factors in Type 1 diabetes. Diabetes Metab Rev. 1998 Mar;14(1):31-67. doi: 10.1002/(sici)1099-0895(199803)14:13.0.co;2-a. PubMed 9605629 ↗
  • Knip M, Akerblom HK. IDDM prevention trials in progress--a critical assessment. J Pediatr Endocrinol Metab. 1998 Apr;11 Suppl 2:371-7. No abstract available. PubMed 9642667 ↗
  • Knip M, Akerblom HK. Environmental factors in the pathogenesis of type 1 diabetes mellitus. Exp Clin Endocrinol Diabetes. 1999;107 Suppl 3:S93-100. doi: 10.1055/s-0029-1212160. PubMed 10522815 ↗
  • Vaarala O, Hyoty H, Akerblom HK. Environmental factors in the aetiology of childhood diabetes. Diabetes Nutr Metab. 1999 Apr;12(2):75-85. No abstract available. PubMed 10554890 ↗
  • Akerblom HK, Vaarala O, Hyoty H, Ilonen J, Knip M. Environmental factors in the etiology of type 1 diabetes. Am J Med Genet. 2002 May 30;115(1):18-29. doi: 10.1002/ajmg.10340. PubMed 12116173 ↗
  • Knip M, Akerblom HK. Early nutrition and later diabetes risk. Adv Exp Med Biol. 2005;569:142-50. doi: 10.1007/1-4020-3535-7_21. PubMed 16137119 ↗
  • Knip M, Veijola R, Virtanen SM, Hyoty H, Vaarala O, Akerblom HK. Environmental triggers and determinants of type 1 diabetes. Diabetes. 2005 Dec;54 Suppl 2:S125-36. doi: 10.2337/diabetes.54.suppl_2.s125. PubMed 16306330 ↗
  • Paronen J, Knip M, Savilahti E, Virtanen SM, Ilonen J, Akerblom HK, Vaarala O. Effect of cow's milk exposure and maternal type 1 diabetes on cellular and humoral immunization to dietary insulin in infants at genetic risk for type 1 diabetes. Finnish Trial to Reduce IDDM in the Genetically at Risk Study Group. Diabetes. 2000 Oct;49(10):1657-65. doi: 10.2337/diabetes.49.10.1657. PubMed 11016449 ↗
  • Hamalainen AM, Ronkainen MS, Akerblom HK, Knip M. Postnatal elimination of transplacentally acquired disease-associated antibodies in infants born to families with type 1 diabetes. The Finnish TRIGR Study Group. Trial to Reduce IDDM in the Genetically at Risk. J Clin Endocrinol Metab. 2000 Nov;85(11):4249-53. doi: 10.1210/jcem.85.11.6987. PubMed 11095462 ↗
  • Ronkainen MS, Hamalainen AM, Koskela P, Akerblom HK, Knip M; Finnish Trigr Study Group. Pregnancy induces nonimmunoglobulin insulin-binding activity in both maternal and cord blood serum. Clin Exp Immunol. 2001 May;124(2):190-6. doi: 10.1046/j.1365-2249.2001.01506.x. PubMed 11422194 ↗
  • Hamalainen AM, Savola K, Kulmala PK, Koskela P, Akerblom HK, Knip M; Finnish TRIGR Study Group. Disease-associated autoantibodies during pregnancy and at birth in families affected by type 1 diabetes. Clin Exp Immunol. 2001 Nov;126(2):230-5. doi: 10.1046/j.1365-2249.2001.01676.x. PubMed 11703365 ↗
  • Sadeharju K, Hamalainen AM, Knip M, Lonnrot M, Koskela P, Virtanen SM, Ilonen J, Akerblom HK, Hyoty H; Finnish TRIGR Study Group. Enterovirus infections as a risk factor for type I diabetes: virus analyses in a dietary intervention trial. Clin Exp Immunol. 2003 May;132(2):271-7. doi: 10.1046/j.1365-2249.2003.02147.x. PubMed 12699416 ↗
  • Akerblom HK, Virtanen SM, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hamalainen AM, Paronen J, Riikjarv MA, Ormisson A, Ludvigsson J, Dosch HM, Hakulinen T, Knip M; National TRIGR Study Groups. Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia. 2005 May;48(5):829-37. doi: 10.1007/s00125-005-1733-3. Epub 2005 Apr 19. Erratum In: Diabetologia. 2005 Aug;48(8):1676. Riikjarv, MA [added]; Ormisson, A [added]; Ludvigsson, J [added]; Dosch, HM [added]; Hakulinen, T [added]; Knip, M [added]. PubMed 15838685 ↗
  • Tiittanen M, Paronen J, Savilahti E, Virtanen SM, Ilonen J, Knip M, Akerblom HK, Vaarala O; Finnish TRIGR Study Group. Dietary insulin as an immunogen and tolerogen. Pediatr Allergy Immunol. 2006 Nov;17(7):538-43. doi: 10.1111/j.1399-3038.2006.00447.x. PubMed 17014631 ↗
  • Sadeharju K, Knip M, Virtanen SM, Savilahti E, Tauriainen S, Koskela P, Akerblom HK, Hyoty H; Finnish TRIGR Study Group. Maternal antibodies in breast milk protect the child from enterovirus infections. Pediatrics. 2007 May;119(5):941-6. doi: 10.1542/peds.2006-0780. PubMed 17473095 ↗
  • Knip M, Virtanen SM, Seppa K, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hamalainen AM, Paronen J, Dosch HM, Hakulinen T, Akerblom HK; Finnish TRIGR Study Group. Dietary intervention in infancy and later signs of beta-cell autoimmunity. N Engl J Med. 2010 Nov 11;363(20):1900-8. doi: 10.1056/NEJMoa1004809. PubMed 21067382 ↗
  • Hyytinen M, Savilahti E, Virtanen SM, Harkonen T, Ilonen J, Luopajarvi K, Uibo R, Vaarala O, Akerblom HK, Knip M; Finnish TRIGR Pilot Study Group. Avoidance of Cow's Milk-Based Formula for At-Risk Infants Does Not Reduce Development of Celiac Disease: A Randomized Controlled Trial. Gastroenterology. 2017 Oct;153(4):961-970.e3. doi: 10.1053/j.gastro.2017.06.049. Epub 2017 Jul 5. PubMed 28687275 ↗
  • de Goffau MC, Luopajarvi K, Knip M, Ilonen J, Ruohtula T, Harkonen T, Orivuori L, Hakala S, Welling GW, Harmsen HJ, Vaarala O. Fecal microbiota composition differs between children with beta-cell autoimmunity and those without. Diabetes. 2013 Apr;62(4):1238-44. doi: 10.2337/db12-0526. Epub 2012 Dec 28. PubMed 23274889 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Nov 28, 2012, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT00570102
Lead sponsor
University of Helsinki
Collaborators
Academy of Finland, European Union, Juvenile Diabetes Research Foundation, Diabetes Research Foundation, Finland, Novo Nordisk A/S
Responsible party
Mikael Knip (Professor of Pediatrics, University of Helsinki) — Principal investigator
First posted
Dec 10, 2007
Start date
Feb 1995
Primary completion
Mar 2004
Completion
Jan 2008
Last update
Nov 28, 2012

Study contacts

Hans K Åkerlom, MD, PhD
principal investigator · University of Helsinki, Helsinki, Finland

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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