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Prevention of Type 1 Diabetes Mellitus

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Principles of Diabetes Mellitus
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Abstract

Type 1 diabetes (T1D) results from the autoimmune destruction of insulin-producing beta cells in the pancreas. Genetic, epigenetic, metabolic, and environmental factors act together to precipitate the onset of the disease. The excess mortality associated with T1D complications and the increasing incidence of childhood T1D emphasize the importance of therapeutic strategies to prevent this chronic metabolic disorder.

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References

  1. https://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf

  2. Rich SS, Concannon P, Erlich H, Julier C, Morahan G, Nerup J, Pociot F, Todd JA. The type 1 diabetes genetics consortium. Ann N Y Acad Sci. 2006;1079:1–8.

    Article  CAS  PubMed  Google Scholar 

  3. Valdes AM, McWeeney S, Thomson G. HLA class II DR-DQ amino acids and insulin-dependent diabetes mellitus: application of the haplotype method. Am J Hum Genet. 1997;60:717–28.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Bennett ST, Wilson AJ, Cucca F, Nerup J, Pociot F, McKinney PA, Barnett AH, Bain SC, Todd JA. IDDM2-VNTR-encoded susceptibility to type 1 diabetes: dominant protection and parental transmission of alleles of the insulin gene-linked minisatellite locus. J Autoimmun. 1996;9:415–21.

    Article  CAS  PubMed  Google Scholar 

  5. Nisticò L, Buzzetti R, Pritchard LE, Van der Auwera B, Giovannini C, Bosi E, Larrad MT, Rios MS, Chow CC, Cockram CS, Jacobs K, Mijovic C, Bain SC, Barnett AH, Vandewalle CL, Schuit F, Gorus FK, Tosi R, Pozzilli P, Todd JA. The CTLA-4 gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Belgian Diabetes Registry. Hum Mol Genet. 1996;5:1075–80.

    Article  PubMed  Google Scholar 

  6. Ladner MB, Bottini N, Valdes AM, Noble JA. Association of the single nucleotide polymorphism C1858T of the PTPN22 gene with type 1 diabetes. Hum Immunol. 2005;66:60–4.

    Article  CAS  PubMed  Google Scholar 

  7. Irizarry RA, Ladd-Acosta C, Wen B, Wu Z, Montano C, Onyango P, Cui H, Gabo K, Rongione M, Webster M, Ji H, Potash JB, Sabunciyan S, Feinberg AP. The human colon cancer methylome shows similar hypo- and hypermethylation at conserved tissue-specific CpG island shores. Nat Genet. 2009;41:178–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bell JT, Spector TD. A twin approach to unraveling epigenetics. Trends Genet. 2011;27:116–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Jiménez-Chillarón JC, Díaz R, Martínez D, Pentinat T, Ramón-Krauel M, Ribó S, Plösch T. The role of nutrition on epigenetic modifications and their implications on health. Biochimie. 2012;94:2242–63.

    Article  PubMed  Google Scholar 

  10. Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes. 2012;1:93–6.

    Article  Google Scholar 

  11. Boerner BP, Sarvetnick NE. Type 1 diabetes: role of intestinal microbiome in humans and mice. Ann N Y Acad Sci. 2011;1243:103–18.

    Article  CAS  PubMed  Google Scholar 

  12. MacFarlane AJ, Strom A, Scott FW. Epigenetics: deciphering how environmental factors may modify autoimmune type 1 diabetes. Mamm Genome. 2009;20:624–32.

    Article  CAS  PubMed  Google Scholar 

  13. Dang MN, Buzzetti R, Pozzilli P. Epigenetics in autoimmune diseases with focus on type 1 diabetes. Diabetes Metab Res Rev. 2013;29:8–18.

    Article  CAS  PubMed  Google Scholar 

  14. Achenbach P, Warncke K, Reiter J, Williams AJ, Ziegler AG, Bingley PJ, Bonifacio E. Type 1 diabetes risk assessment: improvement by follow-up measurements in young islet autoantibody-positive relatives. Diabetologia. 2006;49:2969–76.

    Article  CAS  PubMed  Google Scholar 

  15. Achenbach P, Warncke K, Reiter J, Naserke HE, Williams AJ, Bingley PJ, Bonifacio E, Ziegler AG. Stratification of type 1 diabetes risk on the basis of islet autoantibody characteristics. Diabetes. 2004;53:384–92.

    Article  CAS  PubMed  Google Scholar 

  16. Bingley PJ, Bonifacio E, Mueller PW. Diabetes Antibody Standardization Program: first assay proficiency evaluation. Diabetes. 2003;52:1128–36.

    Article  CAS  PubMed  Google Scholar 

  17. Mueller PW, Bingley PJ, Bonifacio E, Steinberg KK, Sampson EJ. Predicting type 1 diabetes using autoantibodies: the latest results from the diabetes autoantibody standardization program. Diabetes Technol Ther. 2002;4:397–400.

    Article  PubMed  Google Scholar 

  18. Devendra D, Eisenbarth GS. Immunologic endocrine disorders. J Allergy Clin Immunol. 2003;111:S624–36.

    Article  CAS  PubMed  Google Scholar 

  19. Strollo R, Vinci C, Arshad MH, Perrett D, Tiberti C, Chiarelli F, Napoli N, Pozzilli P, Nissim A. Antibodies to post-translationally modified insulin in type 1 diabetes. Diabetologia. 2015;58:2851–2860.

    Google Scholar 

  20. Peng H, Hagopian W. Environmental factors in the development of Type 1 diabetes. Rev Endocr Metab Disord. 2006;7:149–62.

    Article  PubMed  Google Scholar 

  21. Burgess MA, Forrest JM. Congenital rubella and diabetes mellitus. Diabetologia. 2009;52(2):369–70.

    Article  CAS  PubMed  Google Scholar 

  22. Gale EA. Congenital rubella: citation virus or viral cause of type 1 diabetes? Diabetologia. 2008;51:1559–66.

    Article  CAS  PubMed  Google Scholar 

  23. Rodriguez-Calvo T, von Herrath MG. Enterovirus infection and type 1 diabetes: closing in on a link? Diabetes. 2015;64:1503–5.

    Article  CAS  PubMed  Google Scholar 

  24. Oikarinen M, Tauriainen S, Honkanen T, Oikarinen S, Vuori K, Kaukinen K, Rantala I, Mäki M, Hyöty H. Detection of enteroviruses in the intestine of type 1 diabetic patients. Clin Exp Immunol. 2008;151:71–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Frisk G, Fohlman J, Kobbah M, Ewald U, Tuvemo T, Diderholm H, Friman G. High frequency of Coxsackie-B-virus-specific IgM in children developing type I diabetes during a period of high diabetes morbidity. J Med Virol. 1985;17:219–27.

    Article  CAS  PubMed  Google Scholar 

  26. Gamble DR, Taylor KW, Cumming H. Coxsackie viruses and diabetes mellitus. Br Med J. 1973;4:260–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. van der Werf N, Kroese FG, Rozing J, Hillebrands JL. Viral infections as potential triggers of type 1 diabetes. Diabetes Metab Res Rev. 2007;23:169–83.

    Article  PubMed  Google Scholar 

  28. Vaarala O. Is type 1 diabetes a disease of the gut immune system triggered by cow’s milk insulin? Adv Exp Med Biol. 2005;569:151–6.

    Article  PubMed  Google Scholar 

  29. Simpson MD, Norris JM. Mucosal immunity and type 1 diabetes: looking at the horizon beyond cow's milk. Pediatr Diabetes. 2008;9:431–3.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cavallo MG, Fava D, Monetini L, Barone F, Pozzilli P. Cell-mediated immune response to beta casein in recent-onset insulin-dependent diabetes: implications for disease pathogenesis. Lancet. 1996;348:926–8.

    Article  CAS  PubMed  Google Scholar 

  31. Monetini L, Cavallo MG, Manfrini S, Stefanini L, Picarelli A, Di Tola M, Petrone A, Bianchi M, La Presa M, Di Giulio C, Baroni MG, Thorpe R, Walker BK, Pozzilli P, IMDIAB Group. Antibodies to bovine beta-casein in diabetes and other autoimmune diseases. Horm Metab Res. 2002;34:455–9.

    Article  CAS  PubMed  Google Scholar 

  32. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678S–88.

    CAS  PubMed  Google Scholar 

  33. Chatfield SM, Brand C, Ebeling PR, Russell DM. Vitamin D deficiency in general medical inpatients in summer and winter. Intern Med J. 2007;37:377–82.

    Article  CAS  PubMed  Google Scholar 

  34. Stene LC, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of Type I diabetes in the offspring. Diabetologia. 2000;43:1093–8.

    Article  CAS  PubMed  Google Scholar 

  35. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358:1500–3.

    Article  CAS  PubMed  Google Scholar 

  36. Driver JP, Foreman O, Mathieu C, van Etten E, Serreze DV. Comparative therapeutic effects of orally administered 1,25-dihydroxyvitamin D(3) and 1alpha-hydroxyvitamin D(3) on type-1 diabetes in non-obese diabetic mice fed a normal-calcaemic diet. Clin Exp Immunol. 2008;151:76–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Tomkovich S, Jobin C. Microbiota and host immune responses: a love-hate relationship. Immunology. 2015;147:1–10. doi: 10.1111/imm.12538.

    Google Scholar 

  38. Alkanani AK, Hara N, Gottlieb PA, Ir D, Robertson CE, Wagner BD, Frank DN, Zipris D. Alterations in intestinal microbiota correlate with susceptibility to type 1 diabetes. Diabetes. 2015;64:3510–20.

    Article  CAS  PubMed  Google Scholar 

  39. McCarter RJ, Hempe JM, Chalew SA. Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: an analysis of data from the Diabetes Control and Complications Trial. Diabetes Care. 2006;29:352–5.

    Article  PubMed  Google Scholar 

  40. Pozzilli P, Manfrini S, Picardi A. Cow’s milk and trials for prevention of Type 1 diabetes. Diabet Med. 2003;20:871–2.

    Article  CAS  PubMed  Google Scholar 

  41. TRIGR Study Group. Study design of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR). Pediatr Diabetes. 2007;8:117–37.

    Article  Google Scholar 

  42. Knip M, Åkerblom HK, Becker D, Dosch HM, Dupre J, Fraser W, Howard N, Ilonen J, Krischer JP, Kordonouri O, Lawson ML, Palmer JP, Savilahti E, Vaarala O, Virtanen SM, TRIGR Study Group. Hydrolyzed infant formula and early β-cell autoimmunity: a randomized clinical trial. JAMA. 2014;311:2279–87.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hummel S, Pflüger M, Hummel M, Bonifacio E, Ziegler AG. Primary dietary intervention study to reduce the risk of islet autoimmunity in children at increased risk for type 1 diabetes: the BABYDIET study. Diabetes Care. 2011;34:1301–5.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gale E, The European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet. 2004;363:925–31.

    Article  CAS  PubMed  Google Scholar 

  45. The European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. Intervening before the onset of Type 1 diabetes: baseline data from the European Nicotinamide Diabetes Intervention Trial (ENDIT). Diabetologia. 2003;46:339–46.

    Article  Google Scholar 

  46. Bingley PJ, Gale EA, European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. Progression to type 1 diabetes in islet cell antibody-positive relatives in the European Nicotinamide Diabetes Intervention Trial: the role of additional immune, genetic and metabolic markers of risk. Diabetologia. 2006;49:881–90.

    Article  CAS  PubMed  Google Scholar 

  47. Pozzilli P, Andreani D. The potential role of nicotinamide in the secondary prevention of IDDM. Diabetes Metab Rev. 1993;9:219–30.

    Article  CAS  PubMed  Google Scholar 

  48. Diabetes Prevention Trial Type 1 Diabetes Study Group. Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med. 2002;346:1685–91.

    Article  Google Scholar 

  49. Skyler JS, Krischer JP, Wolfsdorf J, Cowie C, Palmer JP, Greenbaum C, Cuthbertson D, Rafkin-Mervis LE, Chase HP, Leschek E. Effects of oral insulin in relatives of patients with type 1 diabetes: the diabetes prevention trial – type 1. Diabetes Care. 2005;28:1068–76.

    Article  CAS  PubMed  Google Scholar 

  50. Pozzilli P. The DPT-1 trial: a negative result with lessons for future type 1 diabetes prevention. Diabetes Metab Res Rev. 2002;18:257–9.

    Article  PubMed  Google Scholar 

  51. Steffes MW, Sibley S, Jackson M, Thomas W. Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial. Diabetes Care. 2003;26:832–6.

    Article  PubMed  Google Scholar 

  52. Pozzilli P, Strollo R. Immunotherapy for Type 1 diabetes: getting beyond a negative first impression. Immunotherapy. 2012;4:655–8.

    Article  CAS  PubMed  Google Scholar 

  53. Wherrett DK, Bundy B, Becker DJ, DiMeglio LA, Gitelman SE, Goland R, Gottlieb PA, Greenbaum CJ, Herold KC, Marks JB, Monzavi R, Moran A, Orban T, Palmer JP, Raskin P, Rodriguez H, Schatz D, Wilson DM, Krischer JP, Skyler JS, Type 1 Diabetes TrialNet GAD Study Group. Antigen-based therapy with glutamic acid decarboxylase (GAD) vaccine in patients with recent-onset Type 1 diabetes: a randomized double-blind trial. Lancet. 2011;378:319–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Ludvigsson J, Krisky D, Casas R, Battelino T, Castaño L, Greening J, Kordonouri O, Otonkoski T, Pozzilli P, Robert JJ, Veeze HJ, Palmer J, Samuelsson U, Elding Larsson H, Åman J, Kärdell G, Neiderud Helsingborg J, Lundström G, Albinsson E, Carlsson A, Nordvall M, Fors H, Arvidsson CG, Edvardson S, Hanås R, Larsson K, Rathsman B, Forsgren H, Desaix H, Forsander G, Nilsson NÖ, Åkesson CG, Keskinen P, Veijola R, Talvitie T, Raile K, Kapellen T, Burger W, Neu A, Engelsberger I, Heidtmann B, Bechtold S, Leslie D, Chiarelli F, Cicognani A, Chiumello G, Cerutti F, Zuccotti GV, Gomez Gila A, Rica I, Barrio R, Clemente M, López Garcia MJ, Rodriguez M, Gonzalez I, Lopez JP, Oyarzabal M, Reeser HM, Nuboer R, Stouthart P, Bratina N, Bratanic N, de Kerdanet M, Weill J, Ser N, Barat P, Bertrand AM, Carel JC, Reynaud R, Coutant R, Baron S. GAD65 antigen therapy in recently diagnosed Type 1 diabetes mellitus. N Engl J Med. 2012;366:433–42.

    Article  CAS  PubMed  Google Scholar 

  55. Sherry N, Hagopian W, Ludvigsson J, Jain SM, Wahlen J, Ferry Jr RJ, Bode B, Aronoff S, Holland C, Carlin D, King KL, Wilder RL, Pillemer S, Bonvini E, Johnson S, Stein KE, Koenig S, Herold KC, Daifotis AG, Protégé Trial Investigators. Teplizumab for treatment of Type 1 diabetes (Protègè study): 1-year results from a randomised, placebo-controlled trial. Lancet. 2011;378:487–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Aronson R, Gottlieb PA, Christiansen JS, Donner TW, Bosi E, Bode BW, Pozzilli P, DEFEND Investigator Group. Low-dose otelixizumab anti-CD3 monoclonal antibody DEFEND-1 study: results of the randomized phase III study in recent-onset human type 1 diabetes. Diabetes Care. 2014;37:2746–54.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Herold KC, Hagopian W, Auger JA, Poumian-Ruiz E, Taylor L, Donaldson D, Gitelman SE, Harlan DM, Xu D, Zivin RA, Bluestone JA. Anti-CD3 monoclonal antibody in new-onset type 1 diabetes mellitus. N Engl J Med. 2002;346:1692–8.

    Article  CAS  PubMed  Google Scholar 

  58. Orban T, Bundy B, Becker DJ, DiMeglio LA, Gitelman SE, Goland R, Gottlieb PA, Greenbaum CJ, Marks JB, Monzavi R, Moran A, Raskin P, Rodriguez H, Russell WE, Schatz D, Wherrett D, Wilson DM, Krischer JP, Skyler JS, Type 1 Diabetes TrialNet Abatacept Study Group. Co-stimulation modulation with abatacept in patients with recent-onset Type 1 diabetes: a randomised, double-blind, placebo-controlled trial. Lancet. 2011;378:412–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Orban T, Bundy B, Becker DJ, Dimeglio LA, Gitelman SE, Goland R, Gottlieb PA, Greenbaum CJ, Marks JB, Monzavi R, Moran A, Peakman M, Raskin P, Russell WE, Schatz D, Wherrett DK, Wilson DM, Krischer JP, Skyler JS, Type 1 Diabetes TrialNet Abatacept Study Group. Costimulation modulation with abatacept in patients with recent-onset type 1 diabetes: follow-up 1 year after cessation of treatment. Diabetes Care. 2014;37:1069–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Moran A, Bundy B, Becker DJ, DiMeglio LA, Gitelman SE, Goland R, Greenbaum CJ, Herold KC, Marks JB, Raskin P, Sanda S, Schatz D, Wherrett DK, Wilson DM, Krischer JP, Skyler JS, Type 1 Diabetes TrialNet Canakinumab Study Group, Pickersgill L, de Koning E, Ziegler AG, Böehm B, Badenhoop K, Schloot N, Bak JF, Pozzilli P, Mauricio D, Donath MY, Castaño L, Wägner A, Lervang HH, Perrild H, Mandrup-Poulsen T, AIDA Study Group. Interleukin-1 antagonism in type 1 diabetes of recent onset: two multicentre, randomised, double-blind, placebo-controlled trials. Lancet. 2013;381:1905–15.

    Google Scholar 

  61. Pescovitz MD, Greenbaum CJ, Bundy B, Becker DJ, Gitelman SE, Goland R, Gottlieb PA, Marks JB, Moran A, Raskin P, Rodriguez H, Schatz DA, Wherrett DK, Wilson DM, Krischer JP, Skyler JS, Type 1 Diabetes TrialNet Anti-CD20 Study Group. B-lymphocyte depletion with rituximab and β-cell function: two-year results. Diabetes Care. 2014;37:453–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Marek-Trzonkowska N, Myśliwiec M, Dobyszuk A, Grabowska M, Derkowska I, Juścińska J, Owczuk R, Szadkowska A, Witkowski P, Młynarski W, Jarosz-Chobot P, Bossowski A, Siebert J, Trzonkowski P. Therapy of type 1 diabetes with CD4(+)CD25(high)CD127-regulatory T cells prolongs survival of pancreatic islets – results of one year follow-up. Clin Immunol. 2014;153:23–30.

    Article  CAS  PubMed  Google Scholar 

  63. The Canadian-European Randomized Control Trial Group. Cyclosporin-induced remission of IDDM after early intervention: association of 1 year of cyclosporin treatment with enhanced insulin secretion. Diabetes. 1988;37:1574–82.

    Article  Google Scholar 

  64. Martin S, Schernthaner G, Nerup J, Gries FA, Koivisto VA, Dupré J, Standl E, Hamet P, McArthur R, Tan MH, et al. Follow-up of cyclosporin A treatment in type (insulin-dependent) diabetes mellitus: lack of long-term effects. Diabetologia. 1991;34:429–34.

    Article  CAS  PubMed  Google Scholar 

  65. Feutren G, Mihatsch MJ. Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases. International Kidney Biopsy Registry of Cyclosporine in Autoimmune Diseases. N Engl J Med. 1992;326:1654–60.

    Article  CAS  PubMed  Google Scholar 

  66. Assan R, Blanchet F, Feutren G, Timsit J, Larger E, Boitard C, Amiel C, Bach JF. Normal renal function 8 to 13 years after cyclosporine A therapy in 285 diabetic patients. Diabetes Metab Res Rev. 2002;18:464–72.

    Article  CAS  PubMed  Google Scholar 

  67. Insel RA, Dunne JL, Atkinson MA, Chiang JL, Dabelea D, Gottlieb PA, Greenbaum CJ, Herold KC, Krischer JP, Lernmark Å, Ratner RE, Rewers MJ, Schatz DA, Skyler JS, Sosenko JM, Ziegler AG. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38:1964–74.

    Article  PubMed  Google Scholar 

  68. Krischer JP, Type 1 Diabetes TrialNet Study Group. The use of intermediate endpoints in the design of type 1 diabetes prevention trials. Diabetologia. 2013;56:1919–24.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Pozzilli P, Maddaloni E, Buzzetti R. Combination immunotherapies for type 1 diabetes mellitus. Nat Rev Endocrinol. 2015;11:289–97.

    Article  CAS  PubMed  Google Scholar 

  70. Suen CS, Burn P. The potential of incretin-based therapies in type 1 diabetes. Drug Discov Today. 2012;17:89–95.

    Article  CAS  PubMed  Google Scholar 

  71. Levetan C, Pozzilli P, Jovanovic L, Schatz D. Proposal for generating new beta cells in a muted environment for type 1 diabetes. Diabetes Metab Res Rev. 2013;29:604–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We thank the Juvenile Diabetes Research Foundation (JDRF), the National Institute of Health (NIH) Consortia, the Centro Internazionale Studi Diabete (CISD), the Diabete e Metabolismo (DEM) Foundation, and University Campus Bio-Medico that support clinical research on type 1 diabetes in our University Hospital.

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Pozzilli, P., Guglielmi, C. (2015). Prevention of Type 1 Diabetes Mellitus. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Cham. https://doi.org/10.1007/978-3-319-20797-1_49-1

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