MMPAD Milan Meeting Report

6 European Roadshow - Milan, 29 June 2018 MEETING REPORT In fact, three stages are recognised in T1D, in which the autoimmune reaction towards beta cells is already present : 3 • Stage 1: Blood sugar is normal, the patient has no symptoms • Stage 2: Blood sugar is impaired when fasting or after eating, there are no symptoms yet • Stage 3: Hyperglycaemia is present and the patient is symptomatic Once stage three has been reached it is too late to prevent the disease. Recognising the disease in its earliest stages allows ketoacidosis to be avoided and an intervention to take place while there is still the possibility of preserving remaining beta cells. Reflection: Predicting T1D is possible thanks to the different emerging biomarkers Fig. 2. T1D predictive markers The most reliable genes in predicting the risk of T1D are still the HLA (especially DR3 / DR4); insulin genes (INS) are also indicative of a significantly increased risk, albeit less than HLA. In children between 3 and 10 years, the presence of anti-islet autoantibodies correlates highly with the risk of developing T1D and, in particular, the presence of 3 antibodies greatly increases the risk compared to the presence of 1-2 antibodies 4, 5 Preventing the onset of T1D So far, efforts to prevent T1D have been very disappointing, with many excellent trials not providing the desired results. Prevention strategies should be stage-specific, based on the prevention of autoimmunity in stage 1 with the addition of beta-cell preservation in the prediabetic phase. In newly developed diabetes the focus should be on glycaemic control, while in full-blown disease it is appropriate to focus on the prevention of complications . 6 Why has prevention not worked? The causes are many and include: the still limited understanding of the pathogenesis and heterogeneity of T1D; the costs of screening; the difficulties of validating markers and identifying molecules able to stop the progression of the disease; and the failure to optimise preventive combination therapies. Immunotherapy