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Prevention of type 1 diabetes
Published on July 28, 2021 47 min
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Welcome to this lecture on "Prevention of Type 1 Diabetes". My name. Is Chantal Mathieu. I'm the Head of Endocrinology at the University Hospital Gasthuisberg and Professor of Medicine at the University of Leuven in Leuven Belgium.
In this lecture, we will discuss the obstacles to prevention of Type 1 diabetes, but also the lessons learned from basic research and clinical trials.
Type 1 diabetes is quite a rare form of diabetes affecting about five percent of all people living with diabetes. This characterized by insulin deficiency and thus insulin treatment is needed for survival. Type 1 diabetes typically affects children and young people, but can also occur in adults. We as clinicians talk about Type 1 diabetes when signs and symptoms of hyperglycemia are present in an individual where we also can find signs of autoimmune attack of the insulin producing beta-cells in the islets of Langerhans in the pancreas. This is reflected very often by the presence of autoantibodies. We have also, however, discovered that Type 1 diabetes is present many months, even many years before we find the clinical signs of hyperglycemia. Therefore we have redefined Type 1 diabetes in different stages. The clinical stage being stage 4. Stage 3 is when individuals have abnormal glucose tolerance when we challenge them with an oral glucose tolerance test and have already autoantibodies present. Stage 2 is when individuals still have enough beta-cells to maintain normal glucose tolerance, but also have signs of autoimmunity as demonstrated by the presence of autoantibodies. We also have now stage 1, which is the stage where we know that there is a predisposition for Type 1 diabetes, but autoimmunity has not started yet. So when talking about prevention, we can define different stages of prevention. Indeed, we can talk about prevention when preventing the progression of an abnormal glucose tolerance to avert Type 1 diabetes. We can also talk about prevention or arrest when preventing going from a normal glucose tolerance to an abnormal glucose tolerance. We even can talk about prevention when we want to prevent autoimmunity altogether.