Emerging Concepts on Disease-Modifying Therapies in Type 1 Diabetes
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Purpose of Review
This review seeks to characterize emerging concepts related to disease-modifying therapy in type 1 diabetes.
We begin by describing the new understanding that islet autoimmunity, as identified by the presence of islet autoantibodies, inevitably leads to clinical type 1 diabetes. This understanding informs the new staging paradigm for type 1 diabetes, which suggests that type 1 diabetes may be recognized and diagnosed long before symptoms develop. Although it is known that nearly all individuals with established islet autoimmunity will eventually develop symptomatic type 1 diabetes (T1D), individual characteristics such as age and biomarker profile may predict rate of disease progression and response to treatment and may therefore be used to individualize therapy.
Key research supports the use of immunotherapy in TID, although a paradigm shift is necessary before immunotherapy may transition from clinical trials to clinical practice. Recent and ongoing research as it relates to these concepts is described throughout.
KeywordsType 1 diabetes research Type 1 diabetes immunotherapy Stages of type 1 diabetes Type 1 diabetes disease course Type 1 diabetes prevention Type 1 diabetes treatment
Compliance with Ethical Standards
Conflict of Interest
Carla Greenbaum reports consultant fees from Lilly, grants and consultant fees from NovoNordisk, consultant fees from Bristol Myers Squibb, grants and consultant fees from Janssen, and consultant fees from Pfizer.
Sandra Lord and Dana VanBuecken declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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