Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Paronen and associates detected insulin autoantibodies more often in
infants with a Type 1 diabetes family history and early exposure to cow
milk, than those not so exposed. The method of measurement used is enzyme
linked immunoassay---which has been shown to predict subsequent diabetes
poorly if at all in many international workshops. T-cell responses to
insulin were also used as a marker. Again, in several international
workshops participating laboratories were unable to verify the predictive
value of such responses on 'blinded' samples.
These observations should not necessarily detract from the authors
observations that a different set of immunological phenomena were
observed in the study and control groups, but merely caution that their
interpretation that the immune responses directly result of from the
bovine insulin present in cow milk may not be correct. The responses
observed may not be predictive of subsequent diabetes.
The comment by Gottleib again raises the issue of the relationship of
cows milk and the development of IDDM. The original observations were in
vitro and have to my knowledge never been confirmed. The American Academy
of Pediatrics suggested that avoiding cows milk was a good idea in infants
to prevent diabetes. It hasn't happened. The incidence of diabetes seems
to be increasing inspite of a resurrgence of breast feeding. Many studies
have shown that early exposure to cows milk does not result in an increase
in clinical diabetes(Couper, Harrison). In vitro tests are fraught with
difficulties particularly when T-cells are involved. They may be surrogate
markers for diabetes but the children have not developed diabetes yet.
And they are only 3 months old!. Lets wait for a longer time and see if
these observations can be repeated and if these children do develop
insulin dependent diabetes.
When are insulin auto-antibodies predictive of diabetes?
Paronen and associates detected insulin autoantibodies more often in
infants with a Type 1 diabetes family history and early exposure to cow
milk, than those not so exposed. The method of measurement used is enzyme
linked immunoassay---which has been shown to predict subsequent diabetes
poorly if at all in many international workshops. T-cell responses to
insulin were also used as a marker. Again, in several international
workshops participating laboratories were unable to verify the predictive
value of such responses on 'blinded' samples.
These observations should not necessarily detract from the authors
observations that a different set of immunological phenomena were
observed in the study and control groups, but merely caution that their
interpretation that the immune responses directly result of from the
bovine insulin present in cow milk may not be correct. The responses
observed may not be predictive of subsequent diabetes.
Competing interests: No competing interests