Giovanna Beauchamp, M.D. and Michael J. Haller, M.D., M.S. recently released a review of several type 1 diabetes (T1D) prevention studies in Current Diabetes Reports. The publication, titled ‘Can We Prevent Type 1 Diabetes?,’ highlights recent and ongoing efforts to understand the causes of T1D, as well potential therapies that might prevent T1D.
“What was most interesting to me about putting this together was learning about the array of past and current studies to prevent or reverse type 1 diabetes,” said Dr. Beauchamp, a fellow in Pediatric Endocrinology at Shands Children’s Hospital. “As a person with T1D, what I found most rewarding was learning about the sense of community in the T1D population starting from patients and their families, to physicians and researchers alike, working towards a common goal.”
Screening
Screening for T1D is crucial to identifying high-risk individuals. Screening can include looking for high-risk HLA, antibodies, or HLA followed by antibodies. UF screens through TrialNet at UF, which involves a simple blood test for the presence of diabetes-related autoantibodies that may appear years before type 1 diabetes develops. TrialNet has established screening sites throughout North America. Please contact us to find a screening location near you, or to a request a test kit, call 877-343-2377.
“Everyone who has a family member with T1D should be screened for T1D risk through TrialNet,” said Haller.
Dietary Intake
Regarding dietary intake, hydrolyzed formulas have shown potential for prevention. One notable hydrolyzed formula study was done by Finnish Dietary Intervention Trial for the Prevention of Type 1 Diabetes. 230 infants identified as having high-risk HLA who had a family member with T1D were randomized to receive either a casein hydrolysate formula (Nutramigen) or a standard cow’s milk-based formula. Antibodies were measured for a 10-year period and provided evidence that ‘dietary intervention via use of a hydrolysate formula may reduce the risk of developing beta-cell autoimmunity,’ according to Beauchamp’s publication.
Another group of researchers found that DHA, an omega-3 fatty acid, may reduce inflammation and prevent the development of islet cell autoimmunity in those at risk.
Antigen-Specific Therapies
Beauchamp and Haller classify antigen-specific immunotherapies as the most highly anticipated efforts in regards to prevention. Unfortunately, past studies found that using small doses of oral insulin to prevent T1D progression has not reduced incidence of T1D. However, a new oral insulin study through TrialNet is about to commence and researchers have high hopes for this low-cost option for patients. Additionally, Pre-POINT is working on a high-dose oral insulin study.
Intranasal insulin is also being studied by the Diabetes Research Centre in Australia and New Zealand.
Another antigen-specific therapy is glutamic acid decarboxylase (GAD). Experiments in the mouse model found that exposure to GAD prevents T1D in mice. The Diabetes Prevention-Immune Tolerance study is currently examining this and concludes in 2017.
Non-Antigen-Specific Immunotherapies
‘While non-antigen-specific immunotherapies may generally be associated with increased risks given their more potent immunosuppressive properties, their use is justified on the basis of equipoise as they are typically reserved for secondary prevention in subjects with established autoimmunity’ (Beauchamp and Haller). Studies in these include examining Abatacept, or CTLA-4-Ig in T lymphocyte activation signals. One study found that doses of Abatacept delay decline of beta-cell function by 9.6 months. There is a current Abatacept study for the Prevention of Abnormal Glucose Tolerance and Diabetes in Relatives At-Risk for Type 1 Diabetes via TrialNet. This study is actively recruiting participants with an anticipated completion date of February 2018.
Cluster of differentiation 3 (CD3) is a cell surface protein that appears on all T cells. CD3 has become a target for the development of monoclonal antibodies aimed at augmenting immune-mediated diseases. Anti-CD3 monoclonal antibodies that have been variably shown to preserve beta-cell function in recent onset T1D. Trials are being conducted through TrialNet now.
Conclusions
UF and other organizations offer a multitude of screening opportunities and T1D studies. Many studies are also in need of controls (individuals without T1D) and those who are high risk but haven’t developed T1D. You can find a full list of UF diabetes studies here and TrialNet at UF studies here.
“It is comforting beyond words to know that so many powerful minds are working as a team for the diabetes community, and that is flattering, humbling, and reassuring of a better future. Research should continue to concentrate on combination therapies with immunomodulatory properties. But most importantly, we have to create awareness of T1D and its growing incidence to enroll patients and their families in research studies that will eventually lead us to the cure, and in the meantime help us improve in all areas of diabetes care,” said Beauchamp.
Original publication:
- Beauchamp G, Haller MJ. (2015) Can We Prevent Type 1 Diabetes? Current Diabetes Reports. 2015 Nov;15(11):86. doi: 10.1007/s11892-015-0658-6.