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TEDDY trial offers potential public health model for type 1 diabetes screening
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CHICAGO — The Environmental Determinants of Diabetes in the Young trial may serve as an appropriate and effective public health model for screening for type 1 diabetes in the general population, William Hagopian, MD, PhD, said here at the ADA Scientific Sessions.
“We’re looking at ways to apply resources toward trying to prevent type 1 diabetes,” he said during a presentation. Unfortunately, he noted, several challenges remain. Some people, for instance, argue that identifying people who will develop type 1 diabetes and benefit from treatment is equivalent to “finding a needle in a haystack” while others contend that it is unethical to identify these individuals without an FDA-approved treatment available to prevent progression to the disease.
William Hagopian
TEDDY, however, may provide evidence supporting screening for type 1 diabetes in all people, not just those at high risk, according to Hagopian, who is scientific director of the Pacific Northwest Diabetes Research Institute in Seattle. The researchers’ goal is to identify environmental factors, including dietary exposures, viruses, diseases and allergies, and genetic–environment interactions that cause islet autoimmunity, he said.
Preliminary results
For the study, the TEDDY Consortium screened the general population and those with a first-degree relative with type 1 diabetes at birth and are following them for the development of islet antibodies and diabetes. Currently, 8,600 participants at six medical centers in Sweden, Finland, Germany, Georgia/Florida, Colorado and Washington State, are enrolled.
Results to date show that the rate of any confirmed islet antibodies was about 6% in the general population and 13% in those with first-degree relatives among those who were followed until about age 5.5 years, Hagopian said. Of those with multiple persistent antibody positivity, the rate of developing type 1 diabetes was approximately 60% in those with first-degree relatives and 48% in the general population after age 4 years. Analysis of trends indicate, however, that these rates will likely equal out and reach about 80%, confirming that the risk with multiple antibody positivity for developing diabetes is high in both the general population and those with a close relative with the disease. These data, Hagopian said, link confirmed multiple islet autoantibody positivity closely to the development of type 1 diabetes.
“It will take longer follow-up in TEDDY to definitively make environment–disease associations, but we have already demonstrated a very successful, population-based prediction strategy for type 1 diabetes,” he said.
Real-world applications
In terms of applying these data to further develop a viable screening process, Hagopian noted a type 1 diabetes prediction testing schedule in which testing is frequent while the child is young and becomes less frequent as the child gets older.
Cost is still a concern, but applying new technologies to decrease the cost of human leukocyte antigen (HLA) testing, and of testing for islet autoantibodies, may help mitigate the issue. Moreover, studies also show that testing costs can be alleviated by having parents collect samples at home or the screening program can be abbreviated to identify patients primarily for secondary prevention trials, which also saves money, according to Hagopian.
Although these are hypothetical, he said, the chief goal is to make testing cost effective and find ways to test new therapies so the research community can move another step toward prevention of type 1 diabetes, which will ultimately decrease medical costs and, most importantly, illness. – by Melissa Foster
For more information:
Hagopian W. Joint ADA/JDRF symposium — Global epidemiology of type 1 diabetes and implications for public health. Presented at: ADA Scientific Sessions; June 21-25, 2013; Chicago.
Disclosure: Hagopian has received research support from Macrogenics, Novartis and Novo Nordisk.