Abstract
Even with modern, advanced treatment, type 1 diabetes (T1D) has significant burdens for those affected. Therefore, prevention of the disease would have large impact, if possible. When considering prevention, it is always necessary to look at benefit versus risk. If the risk for developing T1D is low, like in a general population, the risks of the prevention must be low, while the risk may be higher if the participants have a high risk of developing the disease. Prevention of T1D may be divided into primary, secondary, and tertiary. Primary prevention aims to avoid developing auto antibodies in healthy individuals. Secondary prevention aims to avoid developing T1D (stage 3 in modern classification) in individuals that have developed autoantibodies. Finally, tertiary prevention tries to preserve insulin secretion capacity in individuals with recent onset T1D. Primary prevention may be given to all individuals in a population, or to those with higher genetic risk after a genetic screening and scoring. Currently, there are no primary prevention that has been shown successful, but there are ongoing studies on for example oral insulin and probiotics. Regarding secondary prevention, teplizumab, which is an anti CD3 monoclonal antibody, was approved in the US in 2022 for the treatment of individuals with stage 2 type 1 diabetes. Stage 2 indicates that they have developed two or several autoantibodies and dysglycemia, and teplizumab has been shown the delay the development of T1D with approximately 3 years. In 2023, three different interventions showed promising results in partly preserving insulin secretion in individuals with recent onset T1D (tertiary prevention): verapamil, anti-viral treatment (pleconaril and ribavirin) and teplizumab. Based on this, the future for possible prevention of T1D is exciting, and brighter than in many years.