Читать книгу Clinical Dilemmas in Diabetes - Группа авторов - Страница 44

Secondary prevention of T1D aims to reduce the incidence of the disease by stopping progression of β‐cell destruction in individuals with signs of such a process. This approach may represent a viable alternative to an actual cure by blocking the autoimmune response while β‐cell mass is still functional. For this reason, in the last few decades, prevention studies have started to focus on subjects at risk of developing the disease, in which the autoimmune process has begun but the β‐cell mass is still preserved. The most‐used approach at this stage of T1D is as an antigen‐specific therapy, based on insulin administration to establish tolerance. Generally, mechanistic long‐term effects of these treatments rely on effector T‐cell depletion with expansion of T regulatory cells (T‐reg) (Figure 2.2).

Three large multicenter trials of diabetes prevention in autoantibody‐positive relatives have been completed. The European Nicotinamide Diabetes Intervention Trial (ENDIT), the Diabetes Prevention Trial‐Type 1 (DPT‐1) and the Type 1 Diabetes Prediction and Prevention Study (DIPP). However, no significant benefits of these treatments on the prevention of clinical onset of T1D were found (Table 2.1).