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TYPE 1 DIABETES MELLITUS IN 2020

Shortening the paths to type 1 diabetes mellitus prevention

Nature Reviews Endocrinology volume 17, pages 73–74 (2021)Cite this article

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The development and application of effective immunotherapies for type 1 diabetes mellitus has lagged behind our ability to identify and stage individuals in pre-clinical stages of disease. This Year in Review addresses advances in immunotherapy aimed towards prevention and our readiness to roll out screening in the broader population.

Key advances

  • Low-dose IL-2 is seemingly safe and expands the number of CD4+CD25+ regulatory T (Treg) cells in children with type 1 diabetes mellitus (T1DM)4.

  • The first study of a monoclonal anti-IL-7R antibody in patients with T1DM finds a dose that reduces effector and memory T cell numbers while preserving Treg cell populations in patients with T1DM6.

  • Post-hoc metabolic outcome analysis of two earlier trials indicates that oral insulin slows the decline of islet metabolic function in high-risk pre-symptomatic individuals9.

  • A successful public health application of islet autoantibody screening was carried out in 2015–2019 in German pre-school children to identify, stage and provide care for children with pre-symptomatic T1DM10.

An early pre-symptomatic phase of type 1 diabetes mellitus (T1DM) can be identified by the presence of circulating autoantibodies against several pancreatic islet β-cell proteins, which has been a key argument for running prevention studies for more than three decades. These studies have largely been restricted to relatives of patients with T1DM, who have a lifetime risk of developing T1DM of 1–6% depending upon the degree of relatedness. Although extensive relative screening programmes have been established1, they only identify a small fraction of patients with T1DM and require several years to recruit patients into phase II prevention trials. Consequently, the path to prevention has been slow. With the 2019 success of the anti-CD3 T1DM prevention treatment2, a pressing need exists to accelerate the path to identify alternative therapies and introduce broader screening. We have chosen to highlight papers from the past year that address this need.

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References

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Authors and Affiliations

  1. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany

    Anette-G. Ziegler

  2. Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany

    Anette-G. Ziegler

  3. German Center for Diabetes Research, Munich, Germany

    Anette-G. Ziegler

  4. Center for Regenerative Therapies Dresden, TU Dresden, Dresden, Germany

    Ezio Bonifacio

  5. Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Dresden, Germany

    Ezio Bonifacio

  6. Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, Munich-Neuherberg, Germany

    Ezio Bonifacio

Authors
  1. Anette-G. Ziegler
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  2. Ezio Bonifacio
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Correspondence to Anette-G. Ziegler.

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The authors declare no competing interests.

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Ziegler, AG., Bonifacio, E. Shortening the paths to type 1 diabetes mellitus prevention. Nat Rev Endocrinol 17, 73–74 (2021). https://doi.org/10.1038/s41574-020-00450-5

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  • DOI: https://doi.org/10.1038/s41574-020-00450-5

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