Can We Predict Type 1 Diabetes in the General Population?

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Abstract
Diabetes-associated autoantibodies have been shown to be useful in the assessment of diabetes risk among first-degree relatives of subjects with type 1 diabetes (1–3), whereas their predictive characteristics are poorly defined in the general population, from which ∼90% of the newly diagnosed patients are derived (4). In a simulation study based on the combination of cross-sectional data from children with newly diagnosed type 1 diabetes and unaffected schoolchildren, Bingley et al. (5) reported earlier that positivity for multiple diabetes-associated autoantibodies was associated with reasonable sensitivity and a relatively high positive predictive value for clinical disease in schoolchildren. In this issue of Diabetes Care , LaGasse et al. (6) confirm the utility of disease-associated autoantibodies in the prediction of type 1 diabetes in the general population, represented by 4,505 schoolchildren from Washington state aged 12–18 years at initial sampling. The authors conclude that teens with at least two defined autoantibodies, i.e., antibodies to insulin, the 65-kDa isoform of GAD, and/or to the protein tyrosine phosphatase-related IA-2/islet cell autoantibody (ICA)-512 molecule, are characterized by a high risk of progression to overt diabetes, and that a screening strategy based on the analysis of insulin autoantibodies and GAD and IA-2 antibodies is highly successful in the assessment of type 1 diabetes risk in adolescents. The conclusions are based on information obtained by recontacting 3,000 of the aforementioned 4,505 schoolchildren (67%) 6–11 years later, with a median interval of 8 years. All but 4 of the 141 children who initially tested positive for at least one autoantibody were reached. Six subjects presented with type 1 diabetes within a median interval of 2.8 years after the initial test, and …

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