Endocrine Abstracts

The Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) was established in 2015 to enable population-scale genetic screening in infancy and to conduct trials of interventions aimed at preventing β-cell autoimmunity and type 1 diabetes (T1D). The GPPAD screening programme offers genetic risk testing to newborns or infants in several European countries, including Germany, Poland, Belgium, Sweden, and the United Kingdom. A genetic risk score (GRS), derived from approximately 46 single-nucleotide polymorphisms (SNPs) encompassing HLA-DR/DQ haplotypes and non-HLA risk loci, together with information on first-degree family history of T1D, is used to stratify risk. Infants whose GRS and family background confer a >10% risk of developing multiple β-cell autoantibodies by age 6 years are identified as high-risk and invited to participate in primary prevention trials.To date, three main trials have been conducted within GPPAD:

- POINT (Primary Oral Insulin Trial), which investigates oral insulin tolerance induction and is due to report results soon;

- SINT1A (Supplementation with Bifidobacterium infantis for Primary Prevention of Type 1 Diabetes), where recruitment is complete and follow-up is ongoing; and

- AVAnT1A (Anti-viral Action against Type 1 Diabetes Autoimmunity), currently open to recruitment, in which the intervention consists of COVID-19 vaccination (three doses starting at 6 months of age) to assess whether antiviral protection reduces the incidence of islet autoimmunity.

Follow-up across all GPPAD trials includes longitudinal monitoring for islet autoantibodies and progression to clinical T1D. GPPAD thus provides a unique infrastructure for large-scale genetic screening and early-life intervention studies aimed at the primary prevention of T1D