[Is prevention of type I diabetes mellitus feasible?]

Since the clinical onset of Type 1 diabetes is preceded by an asymptomatic period or prediabetes identified by specific immunogenetic markers, it is possible to imagine specific ways to prevent the onset of the disease in high risk individuals. Such trials will concern mainly first-degree relatives of diabetic patients enrolled into screening programs. The number of individuals necessary to be included in these trials will be function of the therapeutic goals and on the efficacy of the drug in pilot studies in high risk individuals, namely ICA positive subjects with low first phase insulin release during IVGTT. The predominant role of cellular immunity is illustrated in the NOD mouse by the preventive effects of treatments directed toward molecules involved in antigen recognition by autoreactive T cells. Identification of the target autoantigens may lead to specific antigen tolerance. Primary prevention is more speculative and depends on the identification of environmental factors which may initiate beta cell autoimmunity in genetically susceptible individuals. The role of cow's milk proteins has been evocated during retrospective studies. Early interventions in high risk individuals is the only possibility to prevent insulin deficiency.