Should We Screen for Risk of Type 1 Diabetes?
- Mikael Knip, MD, PHD12
- 1Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
- 2Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Address correspondence and reprint requests to Mikael Knip, MD, PhD, Hospital for Children and Adolescents, University of Helsinki, P.O. Box 22, FI-00014 Helsinki, Finland. E-mail: mikael.knip{at}hus.fi
- DPT-1, Diabetes Prevention Trial–Type 1
- FPIR, first-phase insulin response islet cell autoantibody
- IVGTT, intravenous glucose tolerance test
- OGTT, oral glucose tolerance test
Thus far, the consensus within the diabetes community has been that we should screen for risk of type 1 diabetes only in the context of research studies. This view follows the World Health Organization recommendation on screening of clinical conditions, which states that you should screen only for diseases for which there is effective prevention or treatment (1). Data from the DAISY study suggest that the identification of subjects at increased risk for type 1 diabetes and prospective monitoring of risk individuals results in early diagnosis of clinical disease and the avoidance of severe metabolic decompensation at diagnosis among those who progress to overt diabetes (2). The Finnish DIPP Study has generated similar experiences by reducing the frequency of diabetic ketoacidosis at diagnosis from 20 to <2% (K. Näntö-Salonen, H. Hyöty, J. Ilonen, R. Veijola, T. Simell, M. Knip, and O. Simell, unpublished data). Given that diabetic ketoacidosis is a potentially life-threatening condition and that severe metabolic decompensation at diagnosis is associated with a reduced residual β-cell function and impaired metabolic control subsequently (3,4), one may ask whether it would be meaningful to screen for high-risk individuals and monitor them sequentially for progression to type 1 diabetes.
In this issue, Sosenko et al. (5) introduce a risk score for type 1 diabetes derived from the Diabetes Prevention Trial–Type 1 (DPT-1) (5). The authors divided the DPT-1 cohort into development and validation samples. From the former, a risk score was established based on a model including the logarithm of BMI, age, the logarithm of fasting C-peptide, and total glucose and C-peptide sums from a 2-h oral glucose tolerance test (OGTT). This risk score strongly predicted type 1 diabetes in the validation sample. The predictive value of the risk score did not increase by including …
