The Diabetologist #26

For Diabetologist
‏ Prevention of Beta-cell Destruction and Preservation for Those with
Existing Type 1 Diabetes
Jane Lee Chiang, MD, and Stephen E. Gitelman, MD
Anti-Inflammatory Agents
European Nicotinamide Diabetes Intervention Trial
(ENDIT). Like DPT-1, ENDIT represented a concerted
European effort to screen over 30,000 individuals to
identify first-degree relatives with autoantibodies and
normal beta-cell function.12Investigators enrolled
subjects in a randomized, double-blinded, placebocontrolled
trial. Rather than an antigen-based approach,
the trial evaluated nicotinamide, which has
demonstrated efficacy in T1D animal models and in
smaller pilot studies. Nicotinamide presumably acts as
a scavenger of a favorable safety profile but failed to
document an effect, possibly due to insufficient doses,
its use at a later stage in autoimmune destruction,
or its inability to effectively block autoimmunity....
Immunosuppressants
‏:‏Anti-CD3‎ Teplizumab. TrialNet has recently launched
a study utilizing an immunosuppressant, teplizumab, a
mAb directed against the CD3 portion of the T-cell receptor,
for the highest-risk members of the prevention
group, with ≥2 autoantibodies and dysglycemia (see
Preservation section). This approach has shown early
initial success in new-onset T1D trials. Subjects in this
risk category are considered to be one step upstream
issue 26 < November. 2013
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