Preventing T1D in people at risk and maintaining insulin independence.

New Cases of T1D are Doubling Every 20 Years

Prevention of T1D is urgent given the increasing new diagnoses around the world. Recent scientific advances are defining more focused research approaches to the prevention of T1D. JDRF prevention research is building on these advances to address this growing epidemic.

The changing frequency of type 1 diabetes across the world with its increasing public health burden and the recent impressive scientific advances have catalyzed a more urgent and focused approach to prevention. The incidence of type 1 diabetes has been increasing for the last three to four decades in the United States, Europe, and Australia. What has become quite striking is that the disease is occurring much earlier in life. In European children one to five years of age, the incidence is increasing at a rate of 5.4 percent annually, a rate much higher than other age groups. This increase in incidence will lead to a doubling of the number of cases in that age group in Europe in this decade. In fact, projections suggest that children between the ages of one to five years will soon represent the peak age of onset of type 1 diabetes in several European countries. Similar trends are being seen in the United States. In addition to this earlier age of onset of type 1 diabetes, the disease is occurring increasingly in individuals who had been previously considered to be at low-moderate genetic risk, suggesting that there is now a lower threshold for developing the disease.

Why in such a short period of time — 30 to 40 years or so — has the incidence increased, the age of onset decreased, and the threshold for risk been lowered for type 1 diabetes? We know that the cause of type 1 diabetes arises from contributions of both genetics and environmental factors. This alteration in the epidemiology of type 1 diabetes appears likely to arise from environmental factors because it is not possible for genetics to change in such a short period of time. We do not know, however, what specifically in the environment has changed. Not only has type 1 diabetes been increasing in young children, but also allergic disorders such as peanut allergy and other food allergies are far more prevalent in children today than in the past, and the overall rate of autoimmune diseases other than type 1 diabetes has also increased. Each of these diseases or disorders shares a common characteristic: a defect in immunoregulation — the process by which the immune system controls and balances all of its various components and their interactions to prevent reactivity to one’s own tissues and organs.

Prevention of type 1 diabetes represents a “cure” for those at-risk of developing the disease, and in fact, will likely represent the most cost-effective cure, and is the only approach in the short-term to impact the incidence and prevalence of the disease. Impetus and traction for progress in the field of prevention of type 1 diabetes has arisen recently from three relatively recent developments. First, an improved understanding of both the type 1 diabetes disease processes and the natural history of the onset of type 1 diabetes during childhood. Second, the ability to screen for the risk of developing type 1 diabetes and to stage more precisely progression of the disease from the initial onset of autoimmunity to insulin dependence. Third, the development of successful therapeutic interventions that can preserve residual beta cell function in recent onset type 1 diabetes and that can now be applied to prevention. Both prevention of beta cell autoimmunity and insulin dependence and prevention of insulin dependence after the onset of autoimmunity are priorities for JDRF.