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Tertiärprävention des Typ-1-Diabetes

Tertiary prevention of type 1 diabetes

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Ansätze zur Tertiärprävention des Typ-1-Diabetes umfassen Interventionen bei oder kurz nach der Manifestation der Hyperglykämie bei bereits fortgeschrittener β-Zell-Destruktion. Ziel der Interventionen ist eine Reversion des Diabetes oder zumindest eine verlangsamte Progression durch den möglichst langfristigen Erhalt der verbleibenden β-Zell-Funktion. Hierbei werden antigengerichtete Ansätze [Behandlung mit Inselantigenen wie Glutamatdecarboxylase (GAD) oder Hitzeschockprotein-60-Peptid (DiaPep277)] von antientzündlichen Behandlungen (Interleukin-1-Rezeptorantagonist, IL-1-RA, Atorvastatin) oder immunzellgerichteten Behandlungen (Anti-CD3, Anti-CD20, Abatacept) unterschieden. Obwohl die bisherigen Studienergebnisse darauf hinweisen, dass die Aufrechterhaltung der noch vorhandenen β-Zell-Funktion prinzipiell möglich ist, hat sich bisher noch keine gesicherte Therapieform etabliert. Nachdem niedrig-dosierte Anti-CD3-Gabe und auch die Vakzinierung mit GAD nicht die erhofften Erfolge zeigten, werden die Ergebnisse aktuell laufender Phase-II/III-Studien zur Tertiärprävention durch andere Ansätze und weitere Erkenntnisse aus Studien zur Stammzelltransplantation mit Spannung erwartet.

Abstract

Tertiary prevention in patients with type 1 diabetes comprises interventions at or shortly after primary manifestation of hyperglycemia when the majority of ß-cells have already been destroyed. The interventions aim to reverse diabetes or at least to ameliorate further progression of ß-cell loss and long-term stabilization of endogenous insulin secretion capability. Antigen-directed therapy and treatment with islet antigens, such as glutamic acid decarboxylase (GAD) or heat shock protein 60 peptide (DiaPep277), as well as anti-inflammatory treatment with atorvastatin, interleukin 1 receptor antagonist (IL1RA) or immune cell directed treatment (anti-CD3, anti-CD20, abatacept) are currently under investigation. Although recent studies suggest that maintaining ß-cell function is possible, there are currently no approved forms of treatment that can be recommended as standard therapy. After low dose anti-CD3 and also treatment with GAD did not show the success expected in recent phase III studies, results from ongoing phase II/III studies for tertiary prevention and further results on stem cell therapy are eagerly awaited.

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Danksagung

Wir danken Hubert Kolb für die Durchsicht des Manuskripts.

Interessenkonflikt

Die korrespondierende Autorin weist auf folgende Beziehungen hin: N.C. Schloot ist Mitarbeiterin der Fa. Lilly Deutschland und vorübergehend vom Deutschen Diabetes-Zentrum beurlaubt. Sie hat Beraterhonorare der Firmen Andromeda Rehovot, Israel, Sensile Medical, Boehringer-Ingelheim und Glaxo-Smith Cline erhalten. Sie war als Referentin für Novo Nordisk, Sanofi- Aventis und im Rahmen des Praxis Update tätig. N.C. Schloot und S. Link waren/sind an der Durchführung von klinischen Studien der Firmen Andromeda, Tolerx, Boehringer-Ingelheim, Bayer und Roche am Deutschen Diabetes-Zentrum beteiligt.

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Authors and Affiliations

  1. Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung, Heinrich-Heine-Universität, Auf’m Hennekamp 65, 40225, Düsseldorf, Deutschland

    S. Link &  N.C. Schloot

  2. Klinik für Stoffwechselkrankheiten, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    N.C. Schloot

  3. Lilly Deutschland, Bad Homburg, Deutschland

    N.C. Schloot

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  1. S. Link
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Correspondence to N.C. Schloot.

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Link, S., Schloot, N. Tertiärprävention des Typ-1-Diabetes. Diabetologe 7, 568–575 (2011). https://doi.org/10.1007/s11428-011-0729-5

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  • DOI: https://doi.org/10.1007/s11428-011-0729-5

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