Prevention strategies

Screening

To prevent T1D effectively, we must have an effective intervention and effective means of identifying persons at risk for the disease. Although we still lack a proven and efficacious intervention, the application of autoantibody and genetic screening allows for precise identification of at-risk populations. The challenge remains to establish T1D screening programs that provide further insight into the pathogenesis of diabetes so that more effective prevention strategies can be developed.

Future

The design and implementation of well-organized and carefully designed randomized, controlled clinical trials within the past 10 years suggest that progress already has been made toward the disease's ultimate prevention. In the United States, the diabetes prevention trial for T1D was launched in 1994 with the goal of determining whether antigen-based therapies using parenteral or oral insulin would prevent or delay the onset of diabetes in at-risk relatives [87]. In the

European Nicotinamide Diabetes Intervention Trial, relatives of T1D probands were randomized to either nicotinamide or placebo [88]. One of the major impediments to effective intervention trials has been the paradox that accurate prediction improves over time, whereas the potential for effective intervention declines (Fig. 3). Although the diabetes prevention trial for T1D and the European Nicotinamide Diabetes Intervention Trial failed to alter the natural history of diabetes, both studies added significantly to our understanding of the natural history of diabetes.

The current prevention trials have generated collaborative interactions across and between continents. Initially piloted in Finland but currently with several collaborative sites in Europe and North America, the Trial to Reduce IDDM in the Genetically at Risk seeks to determine whether genetically at-risk infants who are not exposed to cow's milk for the first 6 months of life will be protected from the subsequent development of diabetes [89]. The most recent prevention/ intervention development is the creation of the multicenter cooperative group known as TrialNet. This collaborative network is similar to the childhood cancer

More Effective Methods for Preventative Intervention

Higher Accuracy in Disease Prediction

More Effective Methods for Preventative Intervention

Higher Accuracy in Disease Prediction

Onset of Overt Type 1 Diabetes

Fig. 3. The ''treatment dilemma'' for T1D. Many studies from animal models of T1D in combination with a much more limited series of investigations in human beings suggest that early intervention not only is more effective in terms of disease prevention but also often requires more benign forms of therapy. In contrast, the ability to identify an individual who will develop T1D (among an at-risk population) increases as the individual approaches onset of overt disease. FPIR, first phase insulin response; GAD, glutamic acid decarboxylase autoantibodies; IAA, insulin autoantibodies; ICA, islet cell autoantibodies; ICA 512, autoantibodies against the islet tyrosine phosphatase; IVGTT, intravenous glucose tolerance test. (Adapted from Atkinson MA, Eisenbarth GS. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet 358(9277):222; with permission.)

Onset of Overt Type 1 Diabetes

Fig. 3. The ''treatment dilemma'' for T1D. Many studies from animal models of T1D in combination with a much more limited series of investigations in human beings suggest that early intervention not only is more effective in terms of disease prevention but also often requires more benign forms of therapy. In contrast, the ability to identify an individual who will develop T1D (among an at-risk population) increases as the individual approaches onset of overt disease. FPIR, first phase insulin response; GAD, glutamic acid decarboxylase autoantibodies; IAA, insulin autoantibodies; ICA, islet cell autoantibodies; ICA 512, autoantibodies against the islet tyrosine phosphatase; IVGTT, intravenous glucose tolerance test. (Adapted from Atkinson MA, Eisenbarth GS. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet 358(9277):222; with permission.)

cooperative groups and enables the undertaking of multiple pilot studies that involve primary and secondary prevention strategies in different population groups at different stages of the disease process. These studies not only will ascertain the efficacy of intervention but also should lead to greater insight into the pathogenesis of the disease.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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