Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review

Prevention of Type 1 Diabetes

In: Diabetes in America [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 2023.
.
Affiliations
Free Books & Documents
Review

Prevention of Type 1 Diabetes

Laura M. Jacobsen et al.
Free Books & Documents

Excerpt

Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells. There is a genetic predisposition to the disease, with the greatest contribution conferred by alleles present within the major histocompatibility complex (MHC; known as the human leukocyte antigen [HLA] region) on the short arm of chromosome 6. Whether the initiation of this immune response results from environmental triggers remains to be determined. Over years, immune infiltration into pancreatic islets leads to beta cell damage, impairment of cell function, and destruction of beta cells. This notion has led to clinical trials to arrest the progression of disease and potentially prevent or reverse the clinical syndrome.

Clinical trials using various immunologic agents have been conducted at multiple stages of the disease process. Primary prevention trials have been conducted in individuals with genetic predisposition who have not yet developed immunologic markers. Secondary prevention trials have been conducted in individuals with two or more type 1 diabetes-related autoantibodies, either during Stage 1 (normal metabolic function) or Stage 2 (abnormal metabolic function). Intervention trials, also referred to as tertiary prevention trials, have been conducted after diagnosis of hyperglycemia (Stage 3), mostly shortly after clinical onset of disease.

This article provides brief summaries of randomized controlled clinical trials that have been performed and mentions some nonrandomized pilot studies. Success has been limited in primary and secondary prevention trials, with one recent and notable exception (teplizumab). Some tertiary intervention trials have demonstrated improved beta cell function, but these studies have not permanently prevented the decline in beta cell function (eventually declining in parallel to controls). Future interventions with combinations of agents that can target multiple immunologic mechanisms may be needed, including strategies to improve regulatory immunity, as well as to replace and restore beta cell function.

PubMed Disclaimer

Conflict of interest statement

Drs. Jacobsen and Schatz reported no conflicts of interest. Dr. Herold reported that he has consulted for Sanofi, Sonoma Biotherapeutics, and Vertex and is on the Scientific Advisory Board for NexImmune. He is listed as a co-inventor on a patent for use of teplizumab for delay/prevention of type 1 diabetes but receives no royalties. Dr. Skyler reported that he: is the Chair of the Strategic Advisory Committee for INNODIA, INNODIA-HARVEST, INNODIA-iVZW, and EDENT1FI; is currently on the Data and Safety Monitoring Boards for three studies of disease-modifying therapies for type 1 diabetes; and has consulted (in the last 12 months) with several companies developing disease-modifying or other therapies for type 1 diabetes, including 4Immune, Abvance, ActoBiotics, Adocia, Avotres, COUR, Imcyse, ImmunoMolecular Therapeutics, Kriya, Novo-Nordisk, Provention Bio, Sanofi, Signos, Vertex, and Viacyte.

References

    1. Eisenbarth GS. Type I diabetes mellitus. A chronic autoimmune disease. N Engl J Med. 1986;314(21):1360-1368. doi:10.1056/NEJM198605223142106 - DOI - PubMed
    1. Bluestone JA, Herold K, Eisenbarth G. Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature. 2010;464(7293):1293-1300. doi:10.1038/nature08933 - DOI - PMC - PubMed
    1. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69-82. doi:10.1016/S0140-6736(13)60591-7 - DOI - PMC - PubMed
    1. Della Manna T, Setian N, Savoldelli RD, et al. Diabetes mellitus in childhood: an emerging condition in the 21st century. Rev Assoc Med Bras. 2016;62(6):594-601. doi:10.1590/1806-9282.62.06.594 - DOI - PubMed
    1. Atkinson MA, Bluestone JA, Eisenbarth GS, et al. How does type 1 diabetes develop? The notion of homicide or β-cell suicide revisited. Diabetes. 2011;60(5):1370-1379. doi:10.2337/db10-1797 - DOI - PMC - PubMed

LinkOut - more resources