OPPORTUNITIES IN PREVENTION
Scientists hope to sustain and build upon recent momentum in the development of agents that can reverse type 1 diabetes after diagnosis.

With the knowledge that patients retain more insulin-producing capacity in the beginning stages of disease than previously thought, early diagnosis is even more crucial. Clinical trials to reverse type 1 diabetes might be more successful if interventions were undertaken during the window of opportunity as close to diagnosis as possible, when the maximum number of functioning beta cells remain.

Currently it is not possible to measure with a high degree of precision just how many functioning beta cells are left at diagnosis. The development of non-invasive imaging technologies that allow investigators to count beta cells in the pancreas or measure insulin-production — much like x-rays allow physicians to visualize broken bones — would help investigators to monitor the effects of new drugs.

Many drugs are simply too toxic for routine use in children or adolescents. New drugs or novel formulations to reverse type 1 diabetes must be developed that are effective for disease reversal, yet safe for use in the vulnerable pediatric population. Antigen-specific immunotherapies are being developed that should prove more restrictive in their effects on the immune system, resulting in potentially fewer side effects and the possibility of their long-term use to control the underlying immune-mediated disease.

BENEFITS OF THIS RESEARCH
An ongoing, vigorous research effort to reverse type 1 diabetes ensures that promising new agents will be tested rapidly in human clinical trials. An efficient and effective means of reversing disease would provide hope to patients and their parents or caregivers who must deal with a shocking diagnosis of type 1 diabetes. Importantly, the potential to reverse disease provides new incentive for early diagnosis, whether through a disease registry or other public-health program. One such program in Colorado demonstrated that children diagnosed with diabetes through a screening and follow-up program were significantly less likely to be hospitalized at disease onset and had better clinical outcomes in the first year after diagnosis than patients in the general population. Thus, patients with established diabetes as well as those who are newly diagnosed will benefit from research to reverse type 1 diabetes.