Strategies for the prevention of autoimmune Type 1 diabetes

Abstract

European experts on autoimmune Type1 diabetes met for 2days in October 2010 in Cambridge, to review the state-of-the-art and to discuss strategies for prevention of Type1 diabetes. Meeting sessions examined the epidemiology of Type1 diabetes; possible underlying causes of the continuing and rapid increase in Type1 diabetes incidence at younger ages; and lessons learned from previous prevention trials. Consensus recommendations from the meeting were: 1. Resources such as national diabetes registries and natural history studies play an essential role in developing and refining assays to be used in screening for risk factors for Type1 diabetes. 2. It is crucial to dissect out the earliest physiological events after birth, which are controlled by the susceptibility genes now identified in Type1 diabetes, and the environmental factors that might affect these phenotypes, in order to bring forward a mechanistic approach to designing future prevention trials. 3. Current interventions at later stages of disease, such as in newly diagnosed Type1 diabetes, have relied mainly on non-antigen-specific mechanisms. For primary prevention-preventing the onset of autoimmunity-interventions must be based on knowledge of the actual disease process such that: participants in a trial would be stratified according the disease-associated molecular phenotypes; the autoantigen(s) and immune responses to them; and the manipulation of the environment, as early as possible in life. Combinations of interventions should be considered as they may allow targeting different components of disease, thus lowering side effects while increasing efficacy. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.