Primary and secondary prevention of Type 1 diabetes

Diabet Med. 2013 Feb;30(2):161-9. doi: 10.1111/dme.12100.


Since type 1 diabetes is an immunologically mediated disease, immune intervention should alter the natural history of the disease. This article reviews prevention studies undertaken either prior to any evidence of autoimmunity (primary prevention) or after the development of islet autoantibodies (secondary prevention). Most immune intervention studies have been conducted in recent-onset type 1 diabetes (tertiary prevention), and these are not reviewed herein. The goal of primary and secondary intervention is to arrest the immune process and thus prevent or delay clinical disease. Primary prevention studies have been conducted in infants with high genetic risk. Interventions tested include several dietary manipulations, including infant formulas free of either cow's milk or of bovine insulin, infant formula supplemented with the omega-3-fatty acid docosahexaenoic acid, delayed introduction of gluten-containing foods, and vitamin D supplementation. Secondary prevention studies have been conducted in both children and adults with diabetes autoantibodies. Interventions tested include nicotinamide, insulin injections, oral insulin, nasal insulin, glutamic acid decarboxylase, and cyclosporine. Underway are secondary prevention studies with teplizumab and with abatacept.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Abatacept
  • Adolescent
  • Adult
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Autoantibodies / blood
  • Child
  • Child, Preschool
  • Cyclosporine / therapeutic use
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / prevention & control*
  • Diabetes Mellitus, Type 1 / therapy
  • Diet / methods*
  • Fatty Acids, Omega-3 / administration & dosage
  • Female
  • Glutamate Decarboxylase / therapeutic use
  • Glutens / administration & dosage
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Immunoconjugates / therapeutic use
  • Infant
  • Infant Formula / pharmacology
  • Infant, Newborn
  • Insulin / therapeutic use*
  • Male
  • Niacinamide / therapeutic use
  • Primary Prevention*
  • Secondary Prevention*
  • Vitamin D / therapeutic use*


  • Antibodies, Monoclonal, Humanized
  • Autoantibodies
  • Fatty Acids, Omega-3
  • Hypoglycemic Agents
  • Immunoconjugates
  • Insulin
  • Vitamin D
  • Niacinamide
  • Abatacept
  • Glutens
  • Cyclosporine
  • Glutamate Decarboxylase
  • teplizumab