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01.12.2020 | Review Article

Prevention strategies for type 1 diabetes: a story of promising efforts and unmet expectations

verfasst von: Anna Kanta, Eliza Lyka, Theocharis Koufakis, Pantelis Zebekakis, Kalliopi Kotsa

Erschienen in: Hormones | Ausgabe 4/2020

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Abstract

A number of studies have investigated primary and secondary prevention strategies for type 1 diabetes (T1D), since early interventions might improve long-term outcomes through the amelioration of immune processes and the preservation of beta-cell mass. Primary prevention trials focus on genetically at-risk individuals prior to the appearance of autoimmunity, whereas secondary prevention trials aim to halt the progression of complete beta-cell destruction in subjects with established islet autoimmunity (IA). Different approaches have been tested so far, focusing on both pharmaceutical (insulin and monoclonal antibodies) and non-pharmaceutical (vitamin D, omega-3 fatty acids, probiotics, and nicotinamide) interventions, as well as on environmental factors that are believed to trigger autoimmunity in T1D (cow’s milk, gluten, and bovine insulin). Albeit certain strategies have displayed efficacy in reducing IA development rates, most efforts have been unsuccessful in preventing the onset of the disease in high-risk individuals. Moreover, significant heterogeneity in study designs, included populations, and explored outcomes renders the interpretation of study results challenging. The aim of this narrative review is to present and critically evaluate primary and secondary prevention strategies for T1D, seeking to fill existing knowledge gaps and providing insight into future directions.

Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ (2010) Epidemiology of type 1 diabetes. Endocrinol Metab Clin N Am 39:481–497. https://doi.org/10.1016/j.ecl.2010.05.011CrossRef

Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, Aschner P, Craig ME (2018) ISPAD clinical practice consensus guidelines 2018: definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 19:7–19. https://doi.org/10.1111/pedi.12773CrossRefPubMedPubMedCentral

Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G, EURODIAB Study Group (2009) Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 373:2027–2033. https://doi.org/10.1016/S0140-6736(09)60568-7CrossRefPubMed

IDF Diabetes Atlas 8th (2017) http://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html. Accessed Oct 15, 2019

Bottazzo GF, Florin-Christensen A, Doniach D (1974) Islet cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet 2:1279–1283. https://doi.org/10.1016/s0140-6736(74)90140-8CrossRefPubMed

Gepts W, Lecompte PM (1981) The pancreatic islets in diabetes. Am J Med 70:105–115. https://doi.org/10.1016/0002-9343(81)90417-4CrossRefPubMed

Eisenbarth GS (1986) Type I diabetes mellitus. A chronic autoimmune disease. N Engl J Med 314:1360–1368. https://doi.org/10.1056/NEJM198605223142106CrossRefPubMed

Weiner HL, Friedman A, Miller A, Khoury SJ, al- Sabbagh A, Santos L, Sayegh M, Nussenblatt RB, Trentham DE, Hafler DA (1994) Oral tolerance: immunologic mechanisms and treatment of animal and human organ-specific autoimmune diseases by oral administration of autoantigens. Annu Rev Immunol 12:809–837. https://doi.org/10.1146/annurev.iy.12.040194.004113CrossRefPubMed

Ploix C, Bergerot I, Fabien N, Perche S, Moulin V, Thivolet C (1998) Protection against autoimmune diabetes with oral insulin is associated with the presence of IL-4 type 2 T-cells in the pancreas and pancreatic lymph nodes. Diabetes 47:39–44. https://doi.org/10.2337/diab.47.1.39CrossRefPubMed

10.

Zhang ZJ, Davidson L, Eisenbarth G, Weiner HL (1991) Suppression of diabetes in nonobese diabetic mice by oral administration of porcine insulin. Proc Natl Acad Sci U S A 88:10252–10256. https://doi.org/10.1073/pnas.88.22.10252CrossRefPubMedPubMedCentral

11.

Gotfredsen CF, Buschard K, Frandsen EK (1985) Reduction of diabetes incidence of BB Wistar rats by early prophylactic insulin treatment of diabetes-prone animals. Diabetologia 28:933–935. https://doi.org/10.1007/bf00703140CrossRefPubMed

12.

Bowman MA, Campbell L, Darrow BL, Ellis TM, Suresh A, Atkinson MA (1996) Immunological and metabolic effects of prophylactic insulin therapy in the NOD-scid/scid adoptive transfer model of IDDM. Diabetes 45:205–208. https://doi.org/10.2337/diab.45.2.205CrossRefPubMed

13.

Diabetes Prevention Trial--Type 1 Diabetes Study Group (2002) Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med 346:1685–1691. https://doi.org/10.1056/NEJMoa012350CrossRef

14.

Skyler JS, Krischer JP, Wolfsdorf J, Cowie C, Palmer JP, Greenbaum C, Cuthbertson D, Rafkin-Mervis LE, Chase HP, Leschek E (2005) Effects of oral insulin in relatives of patients with type 1 diabetes: the diabetes prevention trial--type 1. Diabetes Care 28:1068–1076. https://doi.org/10.2337/diacare.28.5.1068CrossRefPubMed

15.

www.clinicaltrials.gov/ct2/show/NCT00004984. Accessed Oct 5, 2019

16.

Writing Committee for the Type 1 Diabetes TrialNet Oral Insulin Study Group, Krischer JP, Schatz DA, Bundy B, Skyler JS, Greenbaum CJ (2017) Effect of oral insulin on prevention of diabetes in relatives of patients with type 1 diabetes: a randomized clinical trial. JAMA 318:1891–1902. https://doi.org/10.1001/jama.2017.17070CrossRef

17.

www.clinicaltrials.gov/ct2/show/NCT00419562. Accessed Oct 5, 2019

18.

Vandemeulebroucke E, Gorus FK, Decochez K, Weets I, Keymeulen B, De Block C, Tits J, Pipeleers DG, Mathieu C, Belgian Diabetes Registry (2009) Insulin treatment in IA-2A-positive relatives of type 1 diabetic patients. Diabetes Metab 35:319–327. https://doi.org/10.1016/j.diabet.2009.02.005CrossRefPubMed

19.

Harrison LC, Honeyman MC, Steele CE, Stone NL, Sarugeri E, Bonifacio E, Couper JJ, Colman PG (2004) Pancreatic beta-cell function and immune responses to insulin after administration of intranasal insulin to humans at risk for type 1 diabetes. Diabetes Care 27:2348–2355. https://doi.org/10.2337/diacare.27.10.2348CrossRefPubMed

20.

www.clinicaltrials.gov/ct2/show/NCT00336674. Accessed Oct 5, 2019

21.

Näntö-Salonen K, Kupila A, Simell S, Siljander H, Salonsaari T, Hekkala A, Korhonen S, Erkkola R, Sipilä JI, Haavisto L, Siltala M, Tuominen J, Hakalax J, Hyöty H, Ilonen J, Veijola R, Simell T, Knip M, Simell O (2008) Nasal insulin to prevent type 1 diabetes in children with HLA genotypes and autoantibodies conferring increased risk of disease: a double-blind, randomised controlled trial. Lancet 372:1746–1755. https://doi.org/10.1016/S0140-6736(08)61309-4CrossRefPubMed

22.

www.clinicaltrials.gov/ct2/show/NCT00223613. Accessed Oct 5, 2019

23.

Bonifacio E, Ziegler AG, Klingensmith G, Schober E, Bingley PJ, Rottenkolber M, Theil A, Eugster A, Puff R, Peplow C, Buettner F, Lange K, Hasford J, Achenbach P, Pre-POINT Study Group (2015) Effects of high-dose oral insulin on immune responses in children at high risk for type 1 diabetes: the Pre-POINT randomized clinical trial. JAMA 313:1541–1549. https://doi.org/10.1001/jama.2015.2928CrossRefPubMed

24.

Towns R, Pietropaolo M (2011) GAD65 autoantibodies and its role as biomarker of type 1 diabetes and latent autoimmune diabetes in adults (LADA). Drugs Future 36:847. https://doi.org/10.1358/dof.2011.036.11.1710754CrossRefPubMedPubMedCentral

25.

Nicholas D, Odumosu O, Langridge WHR (2011) Autoantigen based vaccines for type 1 diabetes. Discov Med 11:293–301PubMedPubMedCentral

26.

www.clinicaltrials.gov/ct2/show/record/NCT01122446. Accessed Oct 5, 2019

27.

Elding Larsson H, Lundgren M, Jonsdottir B, Cuthbertson D, Krischer J, DiAPREV-IT Study Group (2018) Safety and efficacy of autoantigen-specific therapy with 2 doses of alum-formulated glutamate decarboxylase in children with multiple islet autoantibodies and risk for type 1 diabetes: a randomized clinical trial. Pediatr Diabetes 19:410–419. https://doi.org/10.1111/pedi.12611CrossRefPubMed

28.

Herold KC, Bundy BN, Long SA, Bluestone JA, DiMeglio LA, Dufort MJ, Gitelman SE, Gottlieb PA, Krischer JP, Linsley PS, Marks JB, Moore W, Moran A, Rodriguez H, Russell WE, Schatz D, Skyler JS, Tsalikian E, Wherrett DK, Ziegler AG, Greenbaum CJ, Type 1 Diabetes TrialNet Study Group (2019) An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes. N Engl J Med 381:603–613. https://doi.org/10.1056/NEJMoa1902226CrossRefPubMedPubMedCentral

29.

www.clinicaltrials.gov/ct2/show/NCT01030861. Accessed Oct 5, 2019

30.

Vital EM, Emery P (2006) Abatacept in the treatment of rheumatoid arthritis. Ther Clin Risk Manag 2:365–375. https://doi.org/10.1080/1744666X.2019.1579642CrossRefPubMedPubMedCentral

31.

www.clinicaltrials.gov/ct2/show/NCT01773707. Accessed Oct 5, 2019

32.

Tian J, Kaufman DL (2009) Antigen-based therapy for the treatment of type 1 diabetes. Diabetes 58:1939–1946. https://doi.org/10.2337/db09-0451CrossRefPubMedPubMedCentral

33.

Gaglia J, Kissler S (2019) Anti-CD3 antibody for the prevention of type 1 diabetes: a story of perseverance. Biochemistry 58(4107):4111. https://doi.org/10.1021/acs.biochem.9b00707CrossRef

34.

Rewers M, Ludvigsson J (2016) Environmental risk factors for type 1 diabetes. Lancet 387:2340–2348. https://doi.org/10.1016/S0140-6736(16)30507-4CrossRefPubMedPubMedCentral

35.

Borch-Johnsen K, Joner G, Mandrup-Poulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J (1984) Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellitus. A hypothesis. Lancet 2:1083–1086. https://doi.org/10.1016/s0140-6736(84)91517-4CrossRefPubMed

36.

Brugman S, Visser JT, HillebrandsJL BNA, Rozing J (2009) Prolonged exclusive breastfeeding reduces autoimmune diabetes incidence and increases regulatory T-cell frequency in bio-breeding diabetes-prone rats. Diabetes Metab Res Rev 25:380–387. https://doi.org/10.1002/dmrr.953CrossRefPubMed

37.

Lund-Blix NA, Dydensborg Sander S, Størdal K, Nybo Andersen AM, Rønningen KS, Joner G, Skrivarhaug T, Njølstad PR, Husby S, Stene LC (2017) Infant feeding and risk of type 1 diabetes in two large Scandinavian birth cohorts. Diabetes Care 40:920–927. https://doi.org/10.2337/dc17-0016CrossRefPubMedPubMedCentral

38.

Lund-Blix NA, Stene LC, Rasmussen T, Torjesen PA, Andersen LF, Rønningen KS (2015) Infant feeding in relation to islet autoimmunity and type 1 diabetes in genetically susceptible children: the MIDIA Study. Diabetes Care 38:257–263. https://doi.org/10.2337/dc14-1130CrossRefPubMed

39.

Knip M, Virtanen SM, Seppä K, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hämäläinen AM, Paronen J, Dosch HM, Hakulinen T, Akerblom HK, Finnish TRIGR Study Group (2010) Dietary intervention in infancy and later signs of beta-cell autoimmunity. N Engl J Med 363:1900–1908. https://doi.org/10.1056/NEJMoa1004809CrossRefPubMedPubMedCentral

40.

Writing Group for the TRIGR Study Group, Knip M, Åkerblom HK, Al Taji E, Becker D, Bruining J, Castano L, Danne T, de Beaufort C, Dosch HM, Dupre J, Fraser WD, Howard N, Ilonen J, Konrad D, Kordonouri O, Krischer JP, Lawson ML, Ludvigsson J, Madacsy L, Mahon JL, Ormisson A, Palmer JP, Pozzilli P, Savilahti E, Serrano-Rios M, Songini M, Taback S, Vaarala O, White NH, Virtanen SM, Wasikowa R (2018) Effect of hydrolyzed infant formula vs conventional formula on risk of type 1 diabetes: the TRIGR randomized clinical trial. JAMA 319:38–48. https://doi.org/10.1001/jama.2017.19826CrossRefPubMedCentral

41.

Hummel S, Beyerlein A, Tamura R, Uusitalo U, Andrén Aronsson C, Yang J, Riikonen A, Lernmark Å, Rewers MJ, Hagopian WA, She JX, Simell OG, Toppari J, Ziegler AG, Akolkar B, Krischer JP, Virtanen SM, Norris JM, TEDDY Study Group (2017) First infant formula type and risk of islet autoimmunity in the environmental determinants of diabetes in the young (TEDDY) study. Diabetes Care 40:398–404. https://doi.org/10.2337/dc16-1624CrossRefPubMedPubMedCentral

42.

Vaarala O, Ilonen J, Ruohtula T, Pesola J, Virtanen SM, Härkönen T, Koski M, KallioinenH TO, Poussa T, Järvenpää AL, Komulainen J, Lounamaa R, Akerblom HK, Knip M (2012) Removal of bovine insulin from cow’s milk formula and early initiation of beta-cell autoimmunity in the FINDIA pilot study. Arch Pediatr Adolesc Med 166:608–614. https://doi.org/10.1001/archpediatrics.2011.1559CrossRefPubMed

43.

Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E (2003) Early infant feeding and risk of developing type 1 diabetes-associated autoantibodies. JAMA 290:1721–1728. https://doi.org/10.1001/jama.290.13.1721CrossRefPubMed

44.

Antvorskov JC, Josefsen K, Engkilde K, Funda DP, Buschard K (2014) Dietary gluten and the development of type 1 diabetes. Diabetologia 57:1770–1780. https://doi.org/10.1007/s00125-014-3265-1CrossRefPubMedPubMedCentral

45.

Lund-Blix NA, Dong F, Mårild K, Seifert J, Barón AE, Waugh KC, Joner G, Størdal K, Tapia G, Stene LC, Johnson RK, Rewers MJ, Norris JM (2019) Gluten intake and risk of islet autoimmunity and progression to type 1 diabetes in children at increased risk of the disease: the diabetes autoimmunity study in the young (DAISY). Diabetes Care 42:789–796. https://doi.org/10.2337/dc18-2315CrossRefPubMedPubMedCentral

46.

Hummel S, Pflüger M, Hummel M, Bonifacio E, Ziegler AG (2011) Primary dietary intervention study to reduce the risk of islet autoimmunity in children at increased risk for type 1 diabetes: the BABYDIET study. Diabetes Care 34:1301–1305. https://doi.org/10.2337/dc10-2456CrossRefPubMedPubMedCentral

47.

Beyerlein A, Chmiel R, Hummel S, Winkler C, Bonifacio E, Ziegler AG (2014) Timing of gluten introduction and islet autoimmunity in young children: updated results from the BABYDIET study. Diabetes Care 37:e194–e195. https://doi.org/10.2337/dc14-1208CrossRefPubMed

48.

Uusitalo U, Lee HS, Andrén Aronsson C, Vehik K, Yang J, Hummel S, Silvis K, Lernmark Å, Rewers M, Hagopian W, SheJX SO, Toppari J, Ziegler AG, Akolkar B, Krischer J, Virtanen SM, Norris JM, TEDDY Study Group (2018) Early infant diet and islet autoimmunity in the TEDDY study. Diabetes Care 41:522–530. https://doi.org/10.2337/dc17-1983CrossRefPubMedPubMedCentral

49.

Jenista JA, Powell KR, Menegus MA (1984) Epidemiology of neonatal enterovirus infection. J Pediatr 104:685–690. https://doi.org/10.1016/s0022-3476(84)80944-0CrossRefPubMed

50.

Catassi C, Bonucci A, Coppa GV, Carlucci A, Giorgi PL (1995) Intestinal permeability changes during the first month: effect of natural versus artificial feeding. J Pediatr Gastroenterol Nutr 21:383–386. https://doi.org/10.1097/00005176-199511000-00003CrossRefPubMed

51.

Lempainen J, Vaarala O, Mäkelä M, Veijola R, Simell O, Knip M, Hermann R, Ilonen J (2009) Interplay between PTPN22 C1858T polymorphism and cow’s milk formula exposure in type 1 diabetes. J Autoimmun 33:155–164. https://doi.org/10.1016/j.jaut.2009.04.003CrossRefPubMed

52.

Han H, Li Y, Fang J, Liu G, Yin J, Li T, Yin Y (2018) Gut microbiota and type 1 diabetes. Int J Mol Sci 19:E995. https://doi.org/10.3390/ijms19040995CrossRefPubMed

53.

Mishra S, Wang S, Nagpal R, Miller B, Singh R, Taraphder S, Yadav H (2019) Probiotics and prebiotics for the amelioration of type 1 diabetes: present and future perspectives. Microorganisms 7:67. https://doi.org/10.3390/microorganisms7030067CrossRefPubMedCentral

54.

Uusitalo U, Liu X, Yang J, Aronsson CA, Hummel S, Butterworth M, Lernmark Å, RewersM HW, She JX, Simell O, Toppari J, Ziegler AG, Akolkar B, Krischer J, Norris JM, Virtanen SM, TEDDY Study Group (2016) Association of early exposure of probiotics and islet autoimmunity in the TEDDY study. JAMA Pediatr 170:20–28. https://doi.org/10.1001/jamapediatrics.2015.2757CrossRefPubMedPubMedCentral

55.

Savilahti E, Härkönen T, Savilahti EM, Kukkonen K, Kuitunen M, Knip M (2018) Probiotic intervention in infancy is not associated with development of beta cell autoimmunity and type 1 diabetes. Diabetologia 61:2668–2670. https://doi.org/10.1007/s00125-018-4738-4CrossRefPubMed

56.

Bi X, Li F, Liu S, Jin Y, Zhang X, Yang T, Dai Y, Li X, Zhao AZ (2017) ω-3 polyunsaturated fatty acids ameliorate type 1 diabetes and autoimmunity. J Clin Invest 127:1757–1771. https://doi.org/10.1172/JCI87388CrossRefPubMedPubMedCentral

57.

Chase HP, Boulware D, Rodriguez H, Donaldson D, Chritton S, Rafkin-Mervis L, Krischer J, Skyler JS, Clare-Salzler M, Type 1 Diabetes TrialNet Nutritional Intervention to Prevent (NIP) Type 1 Diabetes Study Group (2015) Effect of docosahexaenoic acid supplementation on inflammatory cytokine levels in infants at high genetic risk for type 1 diabetes. Pediatr Diabetes 16:271–279. https://doi.org/10.1111/pedi.12170CrossRefPubMed

58.

Norris JM, Yin X, Lamb MM, Barriga K, Seifert J, Hoffman M, Orton HD, Barón AE, Clare-Salzler M, Chase HP, Szabo NJ, Erlich H, Eisenbarth GS, Rewers M (2007) Omega-3 polyunsaturated fatty acid intake and islet autoimmunity in children at increased risk for type 1 diabetes. JAMA 298:1420–1428. https://doi.org/10.1001/jama.298.12.1420CrossRefPubMed

59.

Takiishi T, Van Belle T, Gysemans C, Mathieu C (2013) Effects of vitamin D on antigen-specific and non-antigen-specific immune modulation: relevance for type 1 diabetes. Pediatr Diabetes 14:81–89. https://doi.org/10.1111/j.1399-5448.2012.00923.xCrossRefPubMed

60.

Zipitis CS, Akobeng AK (2008) Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child 93:512–517. https://doi.org/10.1136/adc.2007.128579CrossRefPubMed

61.

Grammatiki M, Karras S, Kotsa K (2019) The role of vitamin D in the pathogenesis and treatment of diabetes mellitus: a narrative review. Hormones (Athens) 18:37–48. https://doi.org/10.1007/s42000-018-0063-zCrossRef

62.

Simpson M, Brady H, Yin X, Seifert J, Barriga K, Hoffman M, Bugawan T, Barón AE, Sokol RJ, Eisenbarth G, Erlich H, Rewers M, Norris JM (2011) No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia 54:2779–2788. https://doi.org/10.1007/s00125-011-2278-2CrossRefPubMedPubMedCentral

63.

Dong JY, Zhang WG, Chen JJ, Zhang ZL, Han SF, Qin LQ (2013) Vitamin D intake and risk of type 1 diabetes: a meta-analysis of observational studies. Nutrients 5:3551–3562. https://doi.org/10.3390/nu5093551CrossRefPubMedPubMedCentral

64.

Wicklow BA, Taback SP (2006) Feasibility of a type 1 diabetes primary prevention trial using 2000 IU vitamin D3 in infants from the general population with increased HLA-associated risk. Ann N Y Acad Sci 1079:310–312. https://doi.org/10.1196/annals.1375.047CrossRefPubMed

65.

Kolb H, Burkart V (1999) Nicotinamide in type 1 diabetes. Mechanism of action revisited. Diabetes Care 22:B16–B20PubMed

66.

Kawasaki E, Abiru N, Eguchi K (2004) Prevention of type 1 diabetes: from the view point of beta cell damage. Diabetes Res Clin Pract 66:S27–S32. https://doi.org/10.1016/j.diabres.2003.09.015CrossRefPubMed

67.

Lampeter EF, Klinghammer A, Scherbaum WA, Heinze E, Haastert B, Giani G, Kolb H (1998) The Deutsche Nicotinamide Intervention Study: an attempt to prevent type 1 diabetes. DENIS Group Diabetes 47:980–984. https://doi.org/10.2337/diabetes.47.6.980CrossRefPubMed

68.

Gale EA, Bingley PJ, Emmett CL, Collier T, European Nicotinamide Diabetes Intervention Trial (ENDIT) Group (2004) European Nicotinamide diabetes intervention trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet 363:925–931. https://doi.org/10.1016/S0140-6736(04)15786-3CrossRefPubMed

69.

Liu C, Wang J, Wan Y, Xia X, Pan J, Gu W, Li M (2018) Serum vitamin D deficiency in children and adolescents is associated with type 1 diabetes mellitus. Endocr Connect 7:1275–1279. https://doi.org/10.1530/EC-18-0191CrossRefPubMedPubMedCentral

70.

Chiarelli F, Giannini C, Primavera M (2019) Prediction and prevention of type 1 diabetes in children. Clin Pediatr Endocrinol 28:43–57. https://doi.org/10.1297/cpe.28.43CrossRefPubMedPubMedCentral

71.

Koufakis T, Katsiki N, Zebekakis P, Dimitriadis G, Kotsa K (2020) Therapeutic approaches for latent autoimmune diabetes in adults: one size does not fit all. J Diabetes 12:110–118. https://doi.org/10.1111/1753-0407.12982CrossRefPubMed

72.

Fellinger P, Fuchs D, Wolf P, Heinze G, Luger A, Krebs M, Winhofer Y (2019) Overweight and obesity in type 1 diabetes equal those of the general population. Wien Klin Wochenschr 131:55–60. https://doi.org/10.1007/s00508-018-1434-9CrossRefPubMedPubMedCentral

73.

Ahmed R, Omidian Z, Giwa A, Cornwell B, Majety N, Bell DR, Lee S, Zhang H, Michels A, Desiderio S, Sadegh-Nasseri S, Rabb H, Gritsch S, Suva ML, Cahan P, Zhou R, Jie C, Donner T, Hamad ARA (2019) A public BCR present in a unique dual-receptor-expressing lymphocyte from type 1 diabetes patients encodes a potent T cell autoantigen. Cell 177:1583–1599. https://doi.org/10.1016/j.cell.2019.05.007CrossRefPubMed

Titel: Prevention strategies for type 1 diabetes: a story of promising efforts and unmet expectations
verfasst von: Anna Kanta
Eliza Lyka
Theocharis Koufakis
Pantelis Zebekakis
Kalliopi Kotsa
Publikationsdatum: 01.12.2020
Verlag: Springer International Publishing
Erschienen in: Hormones / Ausgabe 4/2020
Print ISSN: 1109-3099
Elektronische ISSN: 2520-8721
DOI: https://doi.org/10.1007/s42000-020-00207-9

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