Changing the landscape for type 1 diabetes: the first step to prevention
Abstract
Over several decades, studies have described the progression of autoimmune diabetes, from the first appearance of autoantibodies until, and after, the diagnosis of clinical disease with hyperglycaemia and insulin dependence. Despite the improved management of type 1 diabetes with exogenous insulin, most patients do not meet clinical glycaemic goals, and diabetes remains an important medical problem that affects children and adults. Clinical and preclinical studies have suggested strategies to prevent the diagnosis of type 1 diabetes in people at risk, but the outcomes of previous clinical trials have not met their primary endpoints of disease prevention or delay. The results from the TN-10 teplizumab prevention trial show that the diagnosis of type 1 diabetes can be delayed by treatment with a FcR non-binding monoclonal antibody to CD3 in people at high risk for disease. This Series paper discusses how this clinical achievement raises new questions about for whom, and when, immunological strategies might be developed to prevent type 1 diabetes, and how to achieve this goal.
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Immunotherapy approaches are being evaluated for their potential use in stage 1 or stage 2 type 1 diabetes to prevent stage 3 clinical type 1 diabetes, and for preservation of b-cell function before and shortly after onset of stage 3 clinical type 1 diabetes.
“Immunotherapy approaches are being evaluated for their potential use in stage 1 ($2 islet autoantibodies but normoglycemia) or stage 2 (autoantibodies and dysglycemia) type 1 diabetes to prevent stage 3 clinical type 1 diabetes, and for the preservation of b-cell function before and shortly after onset of stage 3 clinical type 1 diabetes (290).”
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- Authors
- Dayan, C. M., Korah, M., Tatovic, D., Bundy, B. N., & Herold, K. C.
- Affiliations
- Cardiff University (GB)
- Yale University (US)
- University of South Florida (US)
- Corresponding author
- Herold, Kevan C
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 394
- Issue
- 10205
- Pages
- 1286-1296
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2972982749
- Cited by
- 96
- References
- 14
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 12 · 2023: 16 · 2022: 16 · 2021: 20 · 2020: 14 · 2019: 1
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01 DK085466, UC4 DK106993, R01 DK057846)
- National Institute of Allergy and Infectious Diseases
- Juvenile Diabetes Research Foundation United States of America
- National Institutes of Health
- Merck
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Keywords
- type 1 diabetes, diabetes prevention, teplizumab, anti-CD3 monoclonal antibody, autoantibodies, disease progression, high-risk individuals, glycemic control
- MeSH terms
- Diabetes Mellitus, Type 1, Humans, Antibodies, Monoclonal, Humanized
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