Page 19 - Read Online

Mathieu et al. Metab Target Organ Damage 2022;2:15 Metabolism and
DOI: 10.20517/mtod.2022.16
Target Organ Damage

Review Open Access

Arresting type 1 diabetes: are we there yet?
Obstacles and opportunities

Chantal Mathieu, Pieter-Jan Martens

Department of Endocrinology, UZ Leuven, Leuven 3000, Belgium.
Correspondence to: Prof. Chantal Mathieu, Department of Endocrinology, UZ Leuven, Herestraat 49, Leuven 3000, Belgium. E-
mail: chantal.mathieu@uzleuven.be

How to cite this article: Mathieu C, Martens PJ. Arresting type 1 diabetes: are we there yet? Obstacles and opportunities. Metab
Target Organ Damage 2022;2:15. https://dx.doi.org/10.20517/mtod.2022.16

Received: 27 Jun 2022 First Decision: 16 Aug 2022 Revised: 1 Sep 2022 Accepted: 9 Sep 2022 Published: 28 Sep 2022

Academic Editor: Ketan K. Dhatariya Copy Editor: Haixia Wang Production Editor: Haixia Wang

Abstract
More than 100 years after the discovery of insulin, the exact etiology and pathophysiology of type 1 diabetes (T1D)
remains elusive, but our knowledge is growing. This leads to louder calls to initiate a risk screening for T1D in the
general population. This risk screening could be based on the genetic risk (in the general population or targeted
HLA genotyping in family members of persons with T1D) or on the screening for autoantibodies in blood (e.g.,
antibodies against insulin, GAD, IA2, or ZnT8). The presence of autoantibodies is known to convey a clearly
increased risk of progressing to T1D, particularly when two or more antibody types are present. It remains a point
of discussion whether screening efforts are cost-effective. At present, in the absence of interventions capable of
delaying the onset of disease, the only benefit of screening is the earlier diagnosis of T1D, thus avoiding life-
threatening diabetic ketoacidosis (DKA). Nevertheless, large consortia (e.g., INNODIA and TrialNet) are currently
focusing on not only disease biomarkers but also biomarkers of therapeutic effect of interventions. All hope is thus
focused on the arrival of intervention strategies that could arrest the ongoing immune destruction of the beta cell
and thus delay clinical disease onset. Thus far, attempts have focused on either protecting the beta cell or arresting
the immune response, but the future seems to be one of combination therapy. Here, we perform a scoping review
on the pathogenesis of T1D, discuss screening strategies, and present promising intervention strategies.

Keywords: Type 1 diabetes, prevention, intervention, cure

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.mtodjournal.net