Islet autoantibodies screening at age 2 and 6 years predicts type 1 diabetes onset: Lancet
USA: Initial screening for islet autoantibodies at 2 years and 6 years is sensitive and efficient for predicting the onset of type 1 diabetes in later childhood, says a recent study published in The Lancet Diabetes & Endocrinology.
Early prediction of childhood type 1 diabetes provides opportunities for disease prevention and reduces ketoacidosis at diagnosis. However, in public health settings only highly efficient approaches are likely to succeed. Therefore, Mohamed Ghalwash, Center for Computational Health, IBM Research, Yorktown Heights, NY, USA, and colleagues set out to identify efficient strategies for initial islet autoantibody screening in children younger than 15 years.
For this purpose, the researchers collected data from Germany (BABYDIAB), Finland (DIPP), the USA (DAISY and DEW-IT), and Sweden (DiPiS) into the Type 1 Diabetes Intelligence (T1DI) cohort. The study included 24 662 children at high diabetes risk enrolled before age 2 years. They were followed up for islet autoantibodies and diabetes until age 15, or type 1 diabetes onset, whichever occurred first.
Islet autoantibodies measured included those against insulinoma antigen 2, glutamic acid decarboxylase, and insulin. The primary outcomes included sensitivity and positive predictive value (PPV) of detected islet autoantibodies, tested at one or two fixed ages, for clinical type 1 diabetes diagnosis.
The study led to the following findings:
· Of the 24 662 participants enrolled in the Type 1 Diabetes Intelligence cohort, 6722 total were followed up to the age of 15 years or until the onset of type 1 diabetes.
· Type 1 diabetes developed by age of 15 years in 672 children, but did not develop in 6050 children.
· Optimal screening ages for two measurements were 2 years and 6 years, yielding a sensitivity of 82% and PPV of 79% for diabetes by age 15 years.
· Autoantibody positivity at the beginning of each test age was highly predictive of diagnosis in the subsequent 2–5·99 years or 6–15-year age intervals.
· Autoantibodies usually appeared before age 6 years even in children diagnosed with diabetes much later in childhood.
The researchers concluded by saying that, "Our findings show that initial screening for islet autoantibodies at two ages (2 years and 6 years) is sensitive and efficient for public health translation. This, however, might require adjustment by country on the basis of population-specific disease characteristics."
Reference:
The study titled, "Two-age islet-autoantibody screening for childhood type 1 diabetes: a prospective cohort study," was published in The Lancet Diabetes & Endocrinology.
DOI: https://doi.org/10.1016/S2213-8587(22)00141-3
