Suggestion for screening for type 1 diabetes at two and six years of age

Screening children at 2 and 6 years of age for islet autoantibodies associated with diabetic Type 1 will identify the majority of people diagnosed with the disease in their mid-teens, according to new data.

Both genetic screening and islet cell autoantibody screening for risk of infection diabetic The first type has become cheaper in recent years. However, to date, most children who undergo this type of screening do so through programs in which family members of people who are already infected are screened, such as the Universal TrialNet.

Some specialists in the field diabetic Type I advocated expanded screening, arguing that awareness of the increased risks could prepare families to recognize early signs of hyperglycaemia and seek medical help to prevent the development of diabetic ketoacidosis.

Potential treatments are currently under development to prevent or delay diabetic Type 1, anti-CD3 monoclonal antibody teplizumab.

However, since the occurrence of diabetic Type 1 is about 1 in 300 ChildrenAny population-wide screening program needs to be implemented as efficiently and cost-effectively as possible with a limited number of tests, says Mohamed Ghallush, of IBM’s Center for Computational Health Research, Yorktown Heights, and colleagues.

The results of his analysis of nearly 25,000 Children From five potential groups from Europe and the United States published online July 5 in The Lancet diabetic & Endocrinology.

“Our results show that initial screening for islet autoantibodies at 2 years of age (2 and 6 years) is sensitive and effective for transfer to public health, but may require country-specific adjustment based on disease characteristics.” He said.

In an accompanying editorial, Maria J. diabetic Type 1 infection highlights the need to identify the most eligible people for screening…This work is an important contribution to the literature.”

However, Dr. Redondo, MPH, Ph.D., professor of pediatrics, diabetic Pediatrics and Endocrinology at Baylor College of Medicine and Texas Children’s Hospital in Houston cautioned: “It remains to be seen whether Glush and colleagues’ approach can work in the general population, as all participants in the matched data set had genetic risk factors for the disease or a close relative of it. diabetic Type 1, where performance is expected to be higher.

He also noted that most participants were of Northern European ancestry and that it was not known whether the same or similar screening strategy could be applied to individuals over 15 years of age, who diabetic The first type of preclinical disease progresses more slowly.

Examination of infants on two occasions was of high sensitivity and specificity

Data were collected from a total of 24,662 participants from five prospective cohorts from Finland (DIPP), Germany (BABYDIAB), Sweden (DiPiS), and the United States (DAISY and DEW-IT).

They were all in great danger for diabetic Type 1 by human leukocyte antigen genotype, and some have first-degree relatives with the disease. Participants underwent annual screening for three bound antibodies diabetic Type I up to the age of 15 years or until it appears diabetic of type 1.

During follow up 672 Children advanced diabetic Type 1 in 15 years and 6050 no. (The rest have not yet reached the age of 15 and have not initially submitted a file diabetic Type 1.) The median age of first appearance of islet antibodies was 4.5 years.

The strategy of screening at 2 years of age was, at 2 and 6 years of age, more sensitive than screening at age one, with a sensitivity of 82% and a positive predictive value of 79% for onset diabetic Type 1 in 15 years.

The predictive value increased with the number of antibodies analyzed. For example, a single islet autoantibody at 2 years of age indicates a 4-year risk diabetic Type 1 at 5.99 years was 31%, while positivity for multiple antibodies at 2 years carried a 4-year risk of 55%.

At 6 years of age, the risk over the next 9 years was 39% if a test It was negative at 2 years and 70% if a test She was positive at 2 years. But overall, a 6-year-old patient with multiple autoantibodies had an 83% overall risk of developing it. diabetic Type 1, regardless of the result a test At the age of two years.

Glush and colleagues reported that the predictive performance of sensitivity as a function of age varies by country, suggesting that optimal ages for antibody testing may vary with geographic region.

Dr. Redondo commented that “the model may require adaptation to local factors that influence the progression and spread of it.” diabetic type 1; Important issues, such as the cost of screening, global access, acceptance, and follow-up support, will need to be addressed for this strategy to become a viable public health option.”

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