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[Prevention of juvenile diabetes (type 1): reality or fiction?]
1Centro per gli stati disendocrini e dismetabolici, Universita degli studi di Roma La Sapienza.
Insights
Understanding type 1 diabetes (IDDM) pathogenesis is key to prevention. Early identification of susceptible individuals and interventions like insulin or nicotinamide show promise for preventing or managing autoimmune diabetes.
Area of Science:
- Immunology
- Endocrinology
- Diabetology
Background:
- Type 1 diabetes (IDDM) pathogenesis knowledge is crucial for disease prevention.
- Primary prevention targets susceptible individuals before beta cell autoimmunity.
- Secondary prevention focuses on individuals with existing immunological or metabolic alterations.
Purpose of the Study:
- To explore strategies for the prevention of type 1 diabetes (IDDM).
- To review current approaches in primary and secondary prevention of IDDM.
- To highlight the potential of insulin and nicotinamide in IDDM management and prevention.
Main Methods:
- Review of pathogenesis knowledge for IDDM.
- Analysis of primary prevention strategies targeting early identification.
- Evaluation of secondary prevention approaches including biomarkers like ICA, anti-insulin antibodies, and GAD antibodies.
- Assessment of interventions such as insulin therapy and nicotinamide administration.
Main Results:
- Insulin may reduce antigen expression in damaged beta cells.
- Nicotinamide demonstrates protective effects against diabetes in animal models.
- Nicotinamide acts as a free radical scavenger, potentially aiding beta cell regeneration.
- Ongoing global multicenter trials are investigating these prevention strategies.
Conclusions:
- Improved understanding of IDDM pathogenesis facilitates prevention efforts.
- Primary and secondary prevention strategies are under active investigation.
- Insulin and nicotinamide represent promising therapeutic avenues for IDDM prevention and management.
Abstract:
A better knowledge of the pathogenesis of type 1 diabetes (IDDM) may open the road to the prevention of the diseases. Primary prevention is meant to identify susceptible subjects, either soon after birth or before the immunological aggression of beta cells. The practical approach in this respect is very difficult because multiple obstacles must be overcome. Secondary prevention involves subjects who already show immunological or metabolic alterations, as the presence of ICA, antiinsulin antibodies, GAD antibodies and a defect of the first phase of insulin secretion. Most authors attach great interest to trials with insulin and nicotinamide. Insulin seems to reduce antigen expression when beta cells are damaged. Nicotinamide exerts a protection toward diabetes in animals, and, as scavanger of free radicals, facilitates beta cell regeneration. Research is going on, all over the world, and special multicenter trials are in progress both in the USA and Europe.