Chapter 5. Can Bombing the Immune System Achieve Lasting Peace in the Pancreas? A Commentary

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. Edwin A.M. Gale

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch5

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Gale, E. A.M. (2002) Can Bombing the Immune System Achieve Lasting Peace in the Pancreas? A Commentary, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch5

Editor Information

  1. 2

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 3

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 4

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 5

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. Medical School Unit, Southmead Hospital, Bristol BS10 5NB, UK

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • β-cell;
  • immune intervention;
  • autoantibody;
  • natural history;
  • prevention;
  • environmental factor;
  • childhood diabetes;
  • mucosal tolerance;
  • immune system

Summary

Prevention of type 1 diabetes currently resides at around the same level as peace on earth: eminently desirable, theoretically possible, not as yet demonstrated. The evidence suggests that useful numbers of β-cells are present in many new-onset patients, that it is possible to influence their survival over years, and that this has the potential to reduce the risk of long-term complications and the fear of hypoglycaemia. These observations provide justification for the immune interventions described in Chapter 4 but do not offer a means of disease prevention. Intervention may be considered at three levels: before detectable abnormalities are present (primary); after development of immune markers but before the onset of hyperglycaemia; and after presentation with over hyperglycaemia. Improved understanding of the disease should aid prevention, but the natural history of the 50% of cases that present in adult life is unclear. Other questions remain and much research still needs to be done while, in the interim, cautious trial of immune intervention therapy at diagnosis should proceed.