The Primary Prevention: What’s Causing the Rise in Type 1 Diabetes—and Can It Be Stopped?

Decades of research have failed to identify the environmental factors behind rising rates of Type 1 diabetes. However, the search has made Type 1 diabetes one of the best studied autoimmune diseases, with a network of clinics and laboratories dedicated to understanding the interplay of genetic and environmental factors behind the disease. This has enabled clinicians to begin testing treatments to prevent diabetes in high-risk patients at the “primary” phase when all there is to go on is genetic risk. This thesis discusses the search for environmental determinants of diabetes in the context of a primary prevention clinical trial underway at the Institute for Diabetes Research in Munich, Germany. The trial and others underway represent a possible answer for the millions of people at high genetic risk for developing Type 1 diabetes, and other associated autoimmune conditions like celiac disease and allergies. They also offer an early view into the promise and pitfalls of precision medicine.