Low-Dose Antithymocyte Globulin: A Pragmatic Approach to Treating Stage 2 Type 1 Diabetes
Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated. Children (n = 6) aged 5-14 years with stage 2 type 1 diabetes received off-label, low-dos...
Saved in:
| Published in | Diabetes care Vol. 47; no. 2; pp. 285 - 289 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Diabetes Association
01.02.2024
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0149-5992 1935-5548 1935-5548 |
| DOI | 10.2337/dc23-1750 |
Cover
| Abstract | Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated.
Children (n = 6) aged 5-14 years with stage 2 type 1 diabetes received off-label, low-dose ATG. HbA1c, C-peptide, continuous glucose monitoring, insulin requirements, and side effects were followed for 18-48 months.
Three subjects (50%) remained diabetes free after 1.5, 3, and 4 years of follow-up, while three developed stage 3 within 1-2 months after therapy. Eighteen months posttreatment, even disease progressors demonstrated near-normal HbA1c (5.1% [32 mmol/mol], 5.6% [38 mmol/mol], and 5.3% [34 mmol/mol]), time in range (93%, 88%, and 98%), low insulin requirements (0.17, 0.18, and 0.34 units/kg/day), and robust C-peptide 90 min after mixed meal (1.3 ng/dL, 2.3 ng/dL, and 1.4 ng/dL).
These observations support additional prospective studies evaluating ATG in stage 2 type 1 diabetes. |
|---|---|
| AbstractList | OBJECTIVE Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated. RESEARCH DESIGN AND METHODS Children (n = 6) aged 5–14 years with stage 2 type 1 diabetes received off-label, low-dose ATG. HbA1c, C-peptide, continuous glucose monitoring, insulin requirements, and side effects were followed for 18–48 months. RESULTS Three subjects (50%) remained diabetes free after 1.5, 3, and 4 years of follow-up, while three developed stage 3 within 1–2 months after therapy. Eighteen months posttreatment, even disease progressors demonstrated near-normal HbA1c (5.1% [32 mmol/mol], 5.6% [38 mmol/mol], and 5.3% [34 mmol/mol]), time in range (93%, 88%, and 98%), low insulin requirements (0.17, 0.18, and 0.34 units/kg/day), and robust C-peptide 90 min after mixed meal (1.3 ng/dL, 2.3 ng/dL, and 1.4 ng/dL). CONCLUSIONS These observations support additional prospective studies evaluating ATG in stage 2 type 1 diabetes. Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated. Children (n = 6) aged 5-14 years with stage 2 type 1 diabetes received off-label, low-dose ATG. HbA1c, C-peptide, continuous glucose monitoring, insulin requirements, and side effects were followed for 18-48 months. Three subjects (50%) remained diabetes free after 1.5, 3, and 4 years of follow-up, while three developed stage 3 within 1-2 months after therapy. Eighteen months posttreatment, even disease progressors demonstrated near-normal HbA1c (5.1% [32 mmol/mol], 5.6% [38 mmol/mol], and 5.3% [34 mmol/mol]), time in range (93%, 88%, and 98%), low insulin requirements (0.17, 0.18, and 0.34 units/kg/day), and robust C-peptide 90 min after mixed meal (1.3 ng/dL, 2.3 ng/dL, and 1.4 ng/dL). These observations support additional prospective studies evaluating ATG in stage 2 type 1 diabetes. Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated.OBJECTIVELow-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying progression from stage 2 to stage 3 has not been evaluated.Children (n = 6) aged 5-14 years with stage 2 type 1 diabetes received off-label, low-dose ATG. HbA1c, C-peptide, continuous glucose monitoring, insulin requirements, and side effects were followed for 18-48 months.RESEARCH DESIGN AND METHODSChildren (n = 6) aged 5-14 years with stage 2 type 1 diabetes received off-label, low-dose ATG. HbA1c, C-peptide, continuous glucose monitoring, insulin requirements, and side effects were followed for 18-48 months.Three subjects (50%) remained diabetes free after 1.5, 3, and 4 years of follow-up, while three developed stage 3 within 1-2 months after therapy. Eighteen months posttreatment, even disease progressors demonstrated near-normal HbA1c (5.1% [32 mmol/mol], 5.6% [38 mmol/mol], and 5.3% [34 mmol/mol]), time in range (93%, 88%, and 98%), low insulin requirements (0.17, 0.18, and 0.34 units/kg/day), and robust C-peptide 90 min after mixed meal (1.3 ng/dL, 2.3 ng/dL, and 1.4 ng/dL).RESULTSThree subjects (50%) remained diabetes free after 1.5, 3, and 4 years of follow-up, while three developed stage 3 within 1-2 months after therapy. Eighteen months posttreatment, even disease progressors demonstrated near-normal HbA1c (5.1% [32 mmol/mol], 5.6% [38 mmol/mol], and 5.3% [34 mmol/mol]), time in range (93%, 88%, and 98%), low insulin requirements (0.17, 0.18, and 0.34 units/kg/day), and robust C-peptide 90 min after mixed meal (1.3 ng/dL, 2.3 ng/dL, and 1.4 ng/dL).These observations support additional prospective studies evaluating ATG in stage 2 type 1 diabetes.CONCLUSIONSThese observations support additional prospective studies evaluating ATG in stage 2 type 1 diabetes. |
| Author | Brusko, Todd M. Schatz, Desmond A. Hosford, Jennifer Bruggeman, Brittany Mathews, Clayton E. Atkinson, Mark A. Foster, Timothy P. Jacobsen, Laura M. Chen, Angela Salmon, Chelsea Haller, Michael J. Wasserfall, Clive Brusko, Maigan A. Cintron, Miriam |
| Author_xml | – sequence: 1 givenname: Timothy P. surname: Foster fullname: Foster, Timothy P. – sequence: 2 givenname: Laura M. orcidid: 0000-0002-5144-7836 surname: Jacobsen fullname: Jacobsen, Laura M. – sequence: 3 givenname: Brittany surname: Bruggeman fullname: Bruggeman, Brittany – sequence: 4 givenname: Chelsea surname: Salmon fullname: Salmon, Chelsea – sequence: 5 givenname: Jennifer surname: Hosford fullname: Hosford, Jennifer – sequence: 6 givenname: Angela surname: Chen fullname: Chen, Angela – sequence: 7 givenname: Miriam surname: Cintron fullname: Cintron, Miriam – sequence: 8 givenname: Clayton E. surname: Mathews fullname: Mathews, Clayton E. – sequence: 9 givenname: Clive surname: Wasserfall fullname: Wasserfall, Clive – sequence: 10 givenname: Maigan A. surname: Brusko fullname: Brusko, Maigan A. – sequence: 11 givenname: Todd M. surname: Brusko fullname: Brusko, Todd M. – sequence: 12 givenname: Mark A. surname: Atkinson fullname: Atkinson, Mark A. – sequence: 13 givenname: Desmond A. surname: Schatz fullname: Schatz, Desmond A. – sequence: 14 givenname: Michael J. orcidid: 0000-0002-2803-1824 surname: Haller fullname: Haller, Michael J. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38117469$$D View this record in MEDLINE/PubMed |
| BookMark | eNpt0ctKxDAUBuAgijNeFr6ABNzooppr27gbvMOAguPCVUnT05lK24xJiszbm8HRxeDqwOFL-Dn_AdrtbQ8InVByyTjPrirDeEIzSXbQmCouEylFvovGhAqVSKXYCB14_0EIESLP99GI55RmIlVj9D61X8mt9YAnfWjCYtVZswqAH1pbDm3TX-MJfnF63unQGDxZLp3VZoGDxTMHcdfP8WvQc8AMz1ZLwBTfNrqEAP4I7dW69XC8mYfo7f5udvOYTJ8fnm4m08RwkYekprqOcVhagVIlNVUqeGpoLmgW0-uSSco4yTNdpbXOtSKE1zWTxhBQIDPND9H5z78x2ucAPhRd4w20re7BDr5giggqZapkpGdb9MMOro_pomIkTYViWVSnGzWUHVTF0jWddqvi92gRXPwA46z3Duo_QkmxLqRYF1KsC4n2asuaJsS72T443bT_vPgG4JSJ2Q |
| CitedBy_id | crossref_primary_10_20517_mtod_2024_12 crossref_primary_10_1007_s40278_024_57978_6 crossref_primary_10_1007_s13340_024_00748_z crossref_primary_10_1007_s40265_025_02150_8 crossref_primary_10_1159_000539120 crossref_primary_10_1159_000543035 crossref_primary_10_20517_mtod_2024_37 |
| Cites_doi | 10.2337/db13-0236 10.2337/dc23-S002 10.2337/dbi20-0054 10.1016/S2213-8587(21)00019-X 10.1056/NEJMoa2006136 10.2337/dc13-0626 10.2337/db19-0057 10.2337/dc18-0494 10.1089/dia.2021.0329 10.1172/JCI78492 10.1001/jama.2023.2064 10.1056/NEJMc2302677 10.1172/jci.insight.161812 10.1056/NEJMoa1902226 10.2337/dc12-0836 10.1210/clinem/dgac343 10.2337/dc15-1419 10.1172/JCI81722 10.1016/j.cmet.2023.06.018 10.2337/dc13-0604 |
| ContentType | Journal Article |
| Copyright | 2024 by the American Diabetes Association. Copyright American Diabetes Association Feb 2024 |
| Copyright_xml | – notice: 2024 by the American Diabetes Association. – notice: Copyright American Diabetes Association Feb 2024 |
| DBID | AAYXX CITATION CGR CUY CVF ECM EIF NPM K9. NAPCQ 7X8 |
| DOI | 10.2337/dc23-1750 |
| DatabaseName | CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Premium MEDLINE - Academic |
| DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Premium MEDLINE - Academic |
| DatabaseTitleList | ProQuest Health & Medical Complete (Alumni) MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1935-5548 |
| EndPage | 289 |
| ExternalDocumentID | 38117469 10_2337_dc23_1750 |
| Genre | Journal Article |
| GrantInformation_xml | – fundername: NIDDK NIH HHS grantid: K12 DK133995 – fundername: CSRD VA grantid: IK2 CX002027 – fundername: NIAID NIH HHS grantid: P01 AI042288 |
| GroupedDBID | --- -ET ..I .XZ 08P 0R~ 18M 29F 2WC 4.4 53G 5GY 5RE 5RS 5VS 6PF 8R4 8R5 AAFWJ AAIKC AAMNW AAWTL AAYEP AAYXX ABOCM ABPPZ ACGFO ACGOD ADBBV AEGXH AENEX AERZD AFOSN AFRAH AHMBA AIAGR ALIPV ALMA_UNASSIGNED_HOLDINGS BAWUL BENPR BTFSW CITATION CS3 DIK DU5 E3Z EBS EDB EMOBN EX3 F5P GX1 H13 HZ~ IAO IEA IHR INH INR IOF IPO KQ8 L7B M0K M5~ O5R O5S O9- OK1 OVD P2P PCD Q2X RHI SV3 TDI TEORI TR2 TWZ VVN W8F WH7 WOQ WOW YHG YOC ZCG ~KM CGR CUY CVF ECM EIF NPM K9. NAPCQ 7X8 |
| ID | FETCH-LOGICAL-c348t-f1af38126de99b1cd6436c18417149ab25123087ad6fa8a9003ff25cc0e9e57a3 |
| ISSN | 0149-5992 1935-5548 |
| IngestDate | Fri Sep 05 10:09:59 EDT 2025 Mon Jun 30 11:57:26 EDT 2025 Mon Jul 21 06:07:05 EDT 2025 Thu Apr 24 22:53:31 EDT 2025 Tue Jul 01 04:29:29 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 2 |
| Language | English |
| License | 2024 by the American Diabetes Association. |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-c348t-f1af38126de99b1cd6436c18417149ab25123087ad6fa8a9003ff25cc0e9e57a3 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
| ORCID | 0000-0002-2803-1824 0000-0002-5144-7836 |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/10834389 |
| PMID | 38117469 |
| PQID | 2920664927 |
| PQPubID | 47715 |
| PageCount | 5 |
| ParticipantIDs | proquest_miscellaneous_2904155695 proquest_journals_2920664927 pubmed_primary_38117469 crossref_primary_10_2337_dc23_1750 crossref_citationtrail_10_2337_dc23_1750 |
| ProviderPackageCode | CITATION AAYXX |
| PublicationCentury | 2000 |
| PublicationDate | 2024-02-01 2024-Feb-01 20240201 |
| PublicationDateYYYYMMDD | 2024-02-01 |
| PublicationDate_xml | – month: 02 year: 2024 text: 2024-02-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States – name: Alexandria |
| PublicationTitle | Diabetes care |
| PublicationTitleAlternate | Diabetes Care |
| PublicationYear | 2024 |
| Publisher | American Diabetes Association |
| Publisher_xml | – name: American Diabetes Association |
| References | Hagopian (2024011919584060500_B4) 2013; 62 Forlenza (2024011919584060500_B11) 2023; 329 Haller (2024011919584060500_B13) 2019; 68 Sims (2024011919584060500_B14) 2022; 71 Nowak (2024011919584060500_B10) 2022; 107 Besser (2024011919584060500_B16) 2013; 36 Rigby (2024011919584060500_B7) 2015; 125 Haller (2024011919584060500_B20) 2015; 125 Jacobsen (2024011919584060500_B19) 2023; 8 Nguyen (2024011919584060500_B21) 2022; 24 Pescovitz (2024011919584060500_B5) 2014; 37 Herold (2024011919584060500_B3) 2019; 381 Dandona (2024011919584060500_B18) 2023; 389 2024011919584060500_B15 Haller (2024011919584060500_B9) 2018; 41 ElSayed (2024011919584060500_B17) 2023; 46 Quattrin (2024011919584060500_B8) 2020; 383 Atkinson (2024011919584060500_B1) 2023; 35 Orban (2024011919584060500_B6) 2014; 37 Insel (2024011919584060500_B2) 2015; 38 von Herrath (2024011919584060500_B12) 2021; 9 |
| References_xml | – volume: 62 start-page: 3901 year: 2013 ident: 2024011919584060500_B4 article-title: Teplizumab preserves C-peptide in recent-onset type 1 diabetes: two-year results from the randomized, placebo-controlled Protégé trial publication-title: Diabetes doi: 10.2337/db13-0236 – volume: 46 start-page: S19 year: 2023 ident: 2024011919584060500_B17 article-title: 2. Classification and diagnosis of diabetes: Standards of Care in Diabetes—2023 publication-title: Diabetes Care doi: 10.2337/dc23-S002 – volume: 71 start-page: 610 year: 2022 ident: 2024011919584060500_B14 article-title: Screening for type 1 diabetes in the general population: a status report and perspective publication-title: Diabetes doi: 10.2337/dbi20-0054 – volume: 9 start-page: 212 year: 2021 ident: 2024011919584060500_B12 article-title: Anti-interleukin-21 antibody and liraglutide for the preservation of β-cell function in adults with recent-onset type 1 diabetes: a randomised, double-blind, placebo-controlled, phase 2 trial publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(21)00019-X – volume: 383 start-page: 2007 year: 2020 ident: 2024011919584060500_B8 article-title: Golimumab and beta-cell function in youth with new-onset type 1 diabetes publication-title: N Engl J Med doi: 10.1056/NEJMoa2006136 – volume: 37 start-page: 453 year: 2014 ident: 2024011919584060500_B5 article-title: B-lymphocyte depletion with rituximab and β-cell function: two-year results publication-title: Diabetes Care doi: 10.2337/dc13-0626 – volume: 68 start-page: 1267 year: 2019 ident: 2024011919584060500_B13 article-title: Low-dose anti-thymocyte globulin preserves C-peptide, reduces HbA1c, and increases regulatory to conventional T-cell ratios in new-onset type 1 diabetes: two-year clinical trial data publication-title: Diabetes doi: 10.2337/db19-0057 – volume: 41 start-page: 1917 year: 2018 ident: 2024011919584060500_B9 article-title: Low-dose anti-thymocyte globulin (ATG) preserves β-cell function and improves HbA1c in new-onset type 1 diabetes publication-title: Diabetes Care doi: 10.2337/dc18-0494 – volume: 24 start-page: 258 year: 2022 ident: 2024011919584060500_B21 article-title: Cost-effectiveness of low-dose antithymocyte globulin versus other immunotherapies for treatment of new-onset type 1 diabetes publication-title: Diabetes Technol Ther doi: 10.1089/dia.2021.0329 – volume: 125 start-page: 448 year: 2015 ident: 2024011919584060500_B20 article-title: Anti-thymocyte globulin/G-CSF treatment preserves β cell function in patients with established type 1 diabetes publication-title: J Clin Invest doi: 10.1172/JCI78492 – volume: 329 start-page: 990 year: 2023 ident: 2024011919584060500_B11 article-title: Effect of verapamil on pancreatic beta cell function in newly diagnosed pediatric type 1 diabetes: a randomized clinical trial publication-title: JAMA doi: 10.1001/jama.2023.2064 – volume: 389 start-page: 958 year: 2023 ident: 2024011919584060500_B18 article-title: Semaglutide in early type 1 diabetes publication-title: N Engl J Med doi: 10.1056/NEJMc2302677 – volume: 8 start-page: e161812 year: 2023 ident: 2024011919584060500_B19 article-title: Responders to low-dose ATG induce CD4+ T cell exhaustion in type 1 diabetes publication-title: JCI Insight doi: 10.1172/jci.insight.161812 – volume: 381 start-page: 603 year: 2019 ident: 2024011919584060500_B3 article-title: An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes publication-title: N Engl J Med doi: 10.1056/NEJMoa1902226 – volume: 36 start-page: 195 year: 2013 ident: 2024011919584060500_B16 article-title: Lessons from the mixed-meal tolerance test: use of 90-minute and fasting C-peptide in pediatric diabetes publication-title: Diabetes Care doi: 10.2337/dc12-0836 – volume: 107 start-page: 2644 year: 2022 ident: 2024011919584060500_B10 article-title: Intralymphatic GAD-alum (Diamyd) improves glycemic control in type 1 diabetes with HLA DR3-DQ2 publication-title: J Clin Endocrinol Metab doi: 10.1210/clinem/dgac343 – volume: 38 start-page: 1964 year: 2015 ident: 2024011919584060500_B2 article-title: Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association publication-title: Diabetes Care doi: 10.2337/dc15-1419 – volume: 125 start-page: 3285 year: 2015 ident: 2024011919584060500_B7 article-title: Alefacept provides sustained clinical and immunological effects in new-onset type 1 diabetes patients publication-title: J Clin Invest doi: 10.1172/JCI81722 – volume: 35 start-page: 1500 year: 2023 ident: 2024011919584060500_B1 article-title: The pathogenic “symphony” in type 1 diabetes: a disorder of the immune system, β cells, and exocrine pancreas publication-title: Cell Metab doi: 10.1016/j.cmet.2023.06.018 – volume: 37 start-page: 1069 year: 2014 ident: 2024011919584060500_B6 article-title: Costimulation modulation with abatacept in patients with recent-onset type 1 diabetes: follow-up 1 year after cessation of treatment publication-title: Diabetes Care doi: 10.2337/dc13-0604 – ident: 2024011919584060500_B15 |
| SSID | ssj0004488 |
| Score | 2.4964216 |
| Snippet | Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in delaying... OBJECTIVE Low-dose antithymocyte globulin (ATG) (2.5 mg/kg) preserves C-peptide and reduces HbA1c in new-onset stage 3 type 1 diabetes, yet efficacy in... |
| SourceID | proquest pubmed crossref |
| SourceType | Aggregation Database Index Database Enrichment Source |
| StartPage | 285 |
| SubjectTerms | Antilymphocyte serum Antilymphocyte Serum - therapeutic use Blood Glucose Blood Glucose Self-Monitoring C-Peptide Child Diabetes Diabetes mellitus (insulin dependent) Diabetes Mellitus, Type 1 - chemically induced Diabetes Mellitus, Type 1 - drug therapy Globulins Glucose monitoring Glycated Hemoglobin Humans Hypoglycemic Agents Insulin Peptides Prospective Studies Research design Side effects Thymocytes |
| Title | Low-Dose Antithymocyte Globulin: A Pragmatic Approach to Treating Stage 2 Type 1 Diabetes |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/38117469 https://www.proquest.com/docview/2920664927 https://www.proquest.com/docview/2904155695 |
| Volume | 47 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELaWIiEuiDcLBRnEASnysrETJ-a24lUhFvWwlZZT5DjO9lA2VZuqKjf-OTOxnc2WIhUu0cqJN4-ZjL-ZzHxDyGuRS20yXrE81pIlsEYwPRUJK-tMCz4VohJYOzz_JvcOki_LdDka_RpWl7TlxPy8sq7kf6QKYyBXrJL9B8n2fwoD8BvkC1uQMGyvJeOvzTn70HTUIjBwCG68uWhdBgUmmLuq8_0TvXK8rLPjTf3UogOLHRs3Zu3wCB3SKI58hszpELSGsY7GerNshZ4eXtzR_qRPxwEzW_rQDhZe62je7wNlWq2sj7tiaKIN5gjjPProR0gDwEVbD4MSPAl5zIM4pWKpcm3uJtbZViVSBuglHxpfR7fplYwPLanr5OMXZe76DF2291x0jAGV4ciz6hhstzm1L611fQYi-D44ucCpBU69QW7yLOu-9H9ebrKEwHvNXRasux9HToVT3_Zn3YY0f_FTOryyuEvueEeDzpzW3CMju75Pbs19KsUD8j0oD91SHhqU5x2d0V51aFAd2jY0qA7tVIdyiqpDYxrU5CE5-PRx8X6P-T4bzIgkb1kd6xqAG5eVVaqMTQUoVRpw_eMMbluXCIGROFJXsta5xth3XfPUmKlVNoV3-hHZWTdr-4RQeIQAcAEk8lgnsjYKEGQuZQkoNbM2r8fkTXhUhfEk9NgL5aj4QyBj8qo_9Ngxr1x10G543oV_MU8LbMAmZaJ4NiYv-91gNvFbmF7b5gyPQW6KVKp0TB47OfVnEVh8nUj19DpX8Izc3rwAu2SnPTmzzwGntuWLTpN-A9PCjlo |
| linkProvider | Geneva Foundation for Medical Education and Research |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Low-Dose+Antithymocyte+Globulin%3A+A+Pragmatic+Approach+to+Treating+Stage+2+Type+1+Diabetes&rft.jtitle=Diabetes+care&rft.au=Foster%2C+Timothy+P.&rft.au=Jacobsen%2C+Laura+M.&rft.au=Bruggeman%2C+Brittany&rft.au=Salmon%2C+Chelsea&rft.date=2024-02-01&rft.issn=0149-5992&rft.eissn=1935-5548&rft.volume=47&rft.issue=2&rft.spage=285&rft.epage=289&rft_id=info:doi/10.2337%2Fdc23-1750&rft.externalDBID=n%2Fa&rft.externalDocID=10_2337_dc23_1750 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0149-5992&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0149-5992&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0149-5992&client=summon |