Interview Prediction and Prevention are Key for Counteracting Type 1 Diabetes

"With the help of type 1 diabetes screening and prevention studies, we want to stop or delay the clinical manifestation of type 1 diabetes in children. Our vision is a world without type 1 diabetes."

Prof. Anette-Gabriele Ziegler, Director of the Institute of Diabetes Research at Helmholtz Munich

Prof. Anette-Gabriele Ziegler is dedicated to identifying mechanisms and predictive markers of type 1 diabetes in early childhood. Her aim is to delay the clinical onset of this chronic disease and to develop novel therapies to prevent the initiation of autoimmunity.

AZ: This award recognizes the impact of type 1 diabetes on each individual patient, society as a whole, and the ongoing research dedicated to the prevention, early diagnosis, and treatment of the disease. It acknowledges our work regarding prediction and prevention of type 1 diabetes and highlights the importance of preventive medicine. The award will play a pivotal role in increasing the relevance of early diagnosis and preventive medicine for type 1 diabetes in our society – this makes me happy.

AZ: Type 1 diabetes is one of the most prevalent chronic diseases in childhood, and the most prevalent metabolic disease. This condition still has a high burden, despite all the fantastic developments in glucose measurement and insulin injection devices, the challenge for families remains substantial. Consequentially, we need therapies that can delay or prevent the clinical manifestation of this disease. To achieve this, an early diagnosis and the ability to diagnose the risk of developing this disease are immensely important.

AZ: When I started to work in this field, I was given a first project: To contribute to one of the first immunotherapy studies worldwide. Patients with type 1 diabetes were treated with Cyclosporin A – a drug that has a dampening effect on the immune system. That study really excited me because it was the beginning of recognizing that type 1 diabetes is not only a metabolic disease but also an autoimmune disease and that there may be other treatment options than insulin.

AZ: We now understand much better how the disease develops and in the US (not yet approved in Europe), we have a first immune modifying therapy to delay the onset of type 1 diabetes. This drug is a milestone in diabetes research and in my career: We have now something available that could complement the insulin treatment – these therapies can change the course of type 1 diabetes and therefore make a big contribution to prevention.

Another important finding was, that the autoimmune process begins in early childhood, within the first two years of life. Thus, there exists a vulnerable period with a heightened risk of developing an autoimmune disease such as type 1 diabetes; importantly, the risk decreases substantially with age. Therefore, an early screening at preschool age and the ability to diagnose the risk to develop this disease already at birth is immensely important.

AZ: Our Fr1da-study clearly shows that the risk of severe metabolic events like diabetic ketoacidosis and psychological stress for those affected and their families can be significantly reduced when the disease is diagnosed and treated as early as possible. Therefore, we have established the Fr1da screening in 2015, a public health screening for early markers of autoimmunity, so-called islet autoantibodies, in Bavaria, Germany. The screening allows us to detect children with a very early stage of type 1 diabetes, where the autoimmune process has already started but symptoms are not yet diagnosable.
Our aim: We want to improve clinical care and provide access to therapies, that delay the clinical manifestation of the disease with drugs, such as the already mentioned drug, named Teplizumab. 

AZ: The realization that the first years of life are the time window in which the risk of developing autoimmunity is particularly high led me and my team to develop studies that elucidate the mechanisms of disease initiation right after birth: We found that early childhood respiratory infections and inflammation increase the risk of islet autoimmunity and that mild elevations in blood glucose levels occur before the onset of autoimmunity. This could indicate that there are environmental modifiers that affect and change the beta cells and only these changes then trigger the autoimmune process.

AZ: Viral infections are possible environmental trigger for autoimmunity: A number of observational birth studies like the BABYDIAB-, the TEDDY-, or the DIPP-stud haveshown that early viral infections  are associated with an increased risk for type 1 diabetes. The recent COVID-19 pandemic showed that the coronavirus SARS CoV-2 might be a trigger, too. In children with a high genetic risk of type 1 diabetes, a COVID-19 infection doubles the likelihood that these children will develop autoantibodies against the islet cells. This was shown by the POInT-study, in which children were examined before and during the pandemic. In addition, the risk of developing autoimmunity is around five times higher if children are infected at a very young age. 

Our idea is therefore, to use GPPAD to test whether vaccination against the  SARS CoV-2 coronavirus in the first year of life has an impact on the development of islet autoimmunity and type 1 diabetes in children with a very high risk of type 1 diabetes. 

AVAnT1A is the name of the recently launched prevention study. We are currently in the process of enrolling children at high risk of type 1 diabetes on the basis of Freder1k, the newborn screening.

Latest update: May 2024