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Should we be screening for type 1 diabetes?
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Clinical perspective: Screening programs should meet several criteria before implementation
As a clinician, unfortunately, I am not very helpful to families of my patients who may have children who are at risk for type 1 diabetes right now.
There are very few options for those people. The main problem is lack of an effective prevention. Yes, we could potentially screen all school-aged or younger children for antibodies against insulin cells and those tests are now very fine, sensitive and specific. But, the problem is what to do with those kids.
From a clinical perspective, a realistic goal for the next five to 10 years would be to find a prevention modality that will lower the risk of diabetes by 20% to 40% and/or delay the onset of diabetes in young children by two, four or seven years.
Delay in onset of clinical disease is a very important goal here, combined with lessening the severity and morbidity associated with diagnosis. These are tangible goals.
 Marian Rewers |
There are several criteria that a screening program must meet: The ability of intervention that will bring some benefit, a highly specific and sensitive test, cost-effectiveness and acceptance among the potential patients, their families and health care providers that this disease is enough to warrant screening and not just for art or science.
Marian Rewers, MD, PhD, Clinical Director, Barbara Davis Center for Childhood Diabetes at the University of Colorado in Aurora.
Research perspective: Hope remains to translate animal models to human prevention of type 1 diabetes
 George Eisenbarth |
From a research perspective, screening for type 1 diabetes tells us about the natural history of the disease, and it should answer some essential questions about the disease, for example environmental factors that trigger type 1 diabetes.
It is estimated that about one in 200 children die at the onset of diabetes in the United States. For the individual, the benefit is being diagnosed when he/she is not sick and preventing morbidity and mortality.
We have reached the stage where we can pick up diabetes and prevent it in animal models. Now, there are clinical trials to prevent it in humans, such as a GAD vaccine.
I hope that we can translate what has happened in our animal models to human prevention of type 1 diabetes. There are a very large number of new trials and new therapies for autoimmune illnesses, so that is a likely result we will see.
George Eisenbarth, MD, PhD, is the Executive Director of the Barbara Davis Center for Childhood Diabetes at the University of Colorado in Aurora.