Evaluation of Preventive Studies in Type 1 Diabetes Mellitus

ABSTRACT

Type 1 diabetes mellitus (DM) is a chronic autoimmune disease in which destruction of the beta cells in the islets of Langerhans results in insulin deficiency and hyperglycemia. We only definitely know that autoimmunity is the most important effector mechanism of type 1 DM. Type 1 DM precipitates in genetically susceptible individuals after an exposure to environmental trigger. According to current data, type 1 DM-associated genes are classified as susceptibility and protective genes. This insidious disease process evolves over a period of years. Prevention of type 1 DM requires detection of the earliest events in the process. Until now, autoantibodies are generally used as a serum biomarker, but current studies about T cell and metabolome might strengthen diagnostic view. Current preventive clinical studies usually focus on environmental factors. During the natural course of type 1 DM, many strategies have been tested at different stages in the form of primary, secondary and tertiary studies. The aim of the intervention studies for type 1 diabetes is to suppress pathogenic autoreactivity, restore/preserve beta cell mass and function to sufficient levels to provide good metabolic control, and to delay or prevent disease development. Therapeutic studies evaluate the effect of antigen specific and non-specific immune interventions, restoration of the damaged beta cells and also combination of these therapies. The results of intervention studies done till now are modulation of autoimmune process and partial prevention of loss of insulin release following the diagnosis. A single long-term effective prevention has not been identified yet.