Islet Autoantibody Screening Reveal Pediatric Type 1 Diabetes Risk

Type 1 diabetes (T1D) is a chronic progressive autoimmune disorder with complex polygenic susceptibility, usually associated with certain HLA alleles (IDDM1 locus). Progression to T1D is typically marked by the presence of islet-specific autoantibodies in the serum. In humans, autoantibodies are present months to years before disease onset.

Public health screening for T1D in its pre-symptomatic stages may reduce disease severity and burden on a population level. Pre-symptomatic T1D increases the risk for developing clinical T1D in children aged two to five years, but can be identified via islet autoantibody screening. The rate of T1D development varies among individuals, possibly due to non-HLA genetic factors and/or environmental factors beyond the initial trigger.

A team of scientists specializing in diabetes and led by the Helmholtz Zentrum München (Munich-Neuherberg, Germany) conducted islet autoantibody screening using the blood samples from 90,632 children aged 1.75 to 5.99 years residing in Bavaria, Germany (median age, 3.1 years; 48.5% girls). Participants with at least two islet autoantibodies were diagnosed with pre-symptomatic T1D. The team established three stages of pre-symptomatic T1D, culminating in clinical T1D (stage 3).

The investigators identified pre-symptomatic T1D in 280 participants. Stage 1 occurred in 196 participants, stage 2 in 17 participants and stage 3 in 26 participants. During follow-up, those with pre-symptomatic T1D had a 24.9% cumulative risk and 9% annualized risk for reaching stage 3 T1D. There was a 28.7% cumulative risk and a 10.6% annualized risk for stage 2 and/or stage 3 T1D for those with stage 1 pre-symptomatic T1D at baseline. There were two cases of diabetic ketoacidosis in the cohort with pre-symptomatic T1D, according to the scientists, who noted that four children who did not have pre-symptomatic T1D at baseline went on to have clinical T1D.

Anette-Gabriele Ziegler, MD, a Professor and lead author of the study, said, “This sort of screening would reduce the number of acute and dangerous cases of type 1 diabetes that we would see. Care would start at a much earlier stage when the child is still feeling well. It gives time to learn about the disease, adjust to the likelihood of clinical disease whenever it occurs.” The study was published on January 28, 2020 in the journal JAMA.

Related Links:
Helmholtz Zentrum München