A number of studies have investigated primary and secondary prevention strategies for type 1 diabetes (T1D), since early interventions might improve long-term outcomes through the amelioration of immune processes and the preservation of beta-cell mass. Primary prevention trials focus on genetically at-risk individuals prior to the appearance of autoimmunity, whereas secondary prevention trials aim to halt the progression of complete beta-cell destruction in subjects with established islet autoimmunity (IA). Different approaches have been tested so far, focusing on both pharmaceutical (insulin and monoclonal antibodies) and non-pharmaceutical (vitamin D, omega-3 fatty acids, probiotics, and nicotinamide) interventions, as well as on environmental factors that are believed to trigger autoimmunity in T1D (cow's milk, gluten, and bovine insulin). Albeit certain strategies have displayed efficacy in reducing IA development rates, most efforts have been unsuccessful in preventing the onset of the disease in high-risk individuals. Moreover, significant heterogeneity in study designs, included populations, and explored outcomes renders the interpretation of study results challenging. The aim of this narrative review is to present and critically evaluate primary and secondary prevention strategies for T1D, seeking to fill existing knowledge gaps and providing insight into future directions.

中文翻译：

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1 型糖尿病的预防策略：充满希望的努力和未满足的期望的故事。

许多研究调查了 1 型糖尿病 (T1D) 的一级和二级预防策略，因为早期干预可能通过改善免疫过程和保留 β 细胞群来改善长期结果。一级预防试验侧重于出现自身免疫病之前存在遗传风险的个体，而二级预防试验旨在阻止已建立胰岛自身免疫 (IA) 的受试者中完全 β 细胞破坏的进展。到目前为止，已经测试了不同的方法，重点是药物（胰岛素和单克隆抗体）和非药物（维生素 D、omega-3 脂肪酸、益生菌和烟酰胺）干预，以及被认为会触发的环境因素T1D 中的自身免疫（牛奶、麸质和牛胰岛素）。尽管某些策略在降低 IA 发展率方面显示出有效性，但大多数努力在预防高风险个体的疾病发作方面都没有成功。此外，研究设计、纳入人群和探索结果的显着异质性使得对研究结果的解释具有挑战性。本叙述性综述的目的是提出并批判性地评估 T1D 的一级和二级预防策略，力求填补现有知识空白并提供对未来方向的洞察。和探索的结果使研究结果的解释具有挑战性。本叙述性综述的目的是提出并批判性地评估 T1D 的一级和二级预防策略，力求填补现有知识空白并提供对未来方向的洞察。和探索的结果使研究结果的解释具有挑战性。本叙述性综述的目的是提出并批判性地评估 T1D 的一级和二级预防策略，力求填补现有知识空白并提供对未来方向的洞察。