Population-based screening for risk factors could help change the course of type 1 diabetes
Researchers have known for some time that the risk of developing type 1 diabetes (T1D) can be detected by looking for the presence of specific autoantibodies. That knowledge has allowed JDRF to support TrialNet, a project that screens close relatives of people with T1D for risk factors and identifies individuals who would potentially benefit from early intervention.
Only 10 to 15 percent of people who develop T1D have close relatives with the disease, however, so researchers are exploring an approach that would allow them to tease out a higher proportion of the at-risk population. Screening healthy children for pre-symptomatic T1D may be the answer.
In a recently published opinion paper in Endocrinology, Diabetes and Obesity, JDRF Chief Scientific Officer Richard Insel, M.D., his colleague Jessica Dunne, Ph.D., and their co-author Anette Ziegler from the Helmholtz Zentrum München and Technische Universität München in Germany, describe the potential benefits of general population screening. They note that early detection would not only help facilitate clinical trials aimed at slowing or preventing progression of T1D, in the short run it could also help prevent acute, potentially deadly conditions such as diabetic ketoacidosis (DKA) from occurring at full onset of the disease.
Researchers are already making inroads toward identifying at-risk children within the general population. Launched in January, the JDRF-funded FR1da Diabetes Model Project in Germany is screening 3 and 4 year olds at well-child visits for the presence of the islet autoantibodies associated with T1D. The detection of more than one islet autoantibody is associated with high risk for developing symptomatic T1D. Children in the Fr1da study who are identified as pre-symptomatic will be given the option to enroll in a natural history study and an intervention trial aimed at stopping progression of the disease and preventing its full onset.
Concrete health benefits from early screening and detection of pre-symptomatic T1D have already been identified. For example, in The Environmental Determinants of Diabetes in the Young (TEDDY)—a longitudinal study that is following kids with first- or second-degree relatives who have T1D and children from the general population with genes that put them at risk—screening newborns significantly reduced the rates of DKA among children who were later diagnosed with symptomatic T1D. But the ultimate goal of early screening is preventing full onset of the disease, and new techniques for detecting pre-symptomatic T1D could pave the way for unprecedented clinical trials of therapies aimed at delaying or preventing the disease in the larger population.