Prevention strategies for type 1 diabetes: a story of promising efforts and unmet expectations
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REVIEW ARTICLE
Prevention strategies for type 1 diabetes: a story of promising efforts and unmet expectations Anna Kanta 1 & Eliza Lyka 1 & Theocharis Koufakis 1 & Pantelis Zebekakis 1 & Kalliopi Kotsa 1 Received: 7 February 2020 / Accepted: 5 May 2020 # Hellenic Endocrine Society 2020
Abstract A number of studies have investigated primary and secondary prevention strategies for type 1 diabetes (T1D), since early interventions might improve long-term outcomes through the amelioration of immune processes and the preservation of beta-cell mass. Primary prevention trials focus on genetically at-risk individuals prior to the appearance of autoimmunity, whereas secondary prevention trials aim to halt the progression of complete beta-cell destruction in subjects with established islet autoimmunity (IA). Different approaches have been tested so far, focusing on both pharmaceutical (insulin and monoclonal antibodies) and nonpharmaceutical (vitamin D, omega-3 fatty acids, probiotics, and nicotinamide) interventions, as well as on environmental factors that are believed to trigger autoimmunity in T1D (cow’s milk, gluten, and bovine insulin). Albeit certain strategies have displayed efficacy in reducing IA development rates, most efforts have been unsuccessful in preventing the onset of the disease in high-risk individuals. Moreover, significant heterogeneity in study designs, included populations, and explored outcomes renders the interpretation of study results challenging. The aim of this narrative review is to present and critically evaluate primary and secondary prevention strategies for T1D, seeking to fill existing knowledge gaps and providing insight into future directions. Keywords Type 1 diabetes . Prevention . Immunotherapy . Insulin . Environmental factors
Introduction Type 1 diabetes (T1D) is caused by the selective autoimmune destruction of the pancreatic insulin-producing beta-cells. More than 500,000 children around the world live with T1D and epidemiological data report that the incidence of the disease has been following an increasing trend over the last few years [1–3], with the International Diabetes Federation declaring 132,600 newly diagnosed T1D cases in 2017 globally [4]. The basic characteristics of the disease include the presence of circulating autoantibodies against beta-cell antigens [5], the infiltration of immune cells into pancreatic islets [6], and the progressive decrease in insulin secretion, finally leading to significant hyperglycemia and disturbance of metabolic equilibrium. Once established, T1D is manageable with insulin administration. However, insulin therapy is not a cure, and since the
discovery of the autoimmune nature of the disease [7], many preventive and therapeutic approaches targeting the immune system have been tested in both human and animal studies. A number of trials have focused on primary and secondary prevention strategies, since early interventions might improve long-term outcomes through the amelioration of immune processes and the preservation of beta-cell mass.
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