Screening for Islet Autoantibodies for T1D Diagnosis Efficient at Early Ages

William Hagopian, MD, PhD

A recent study aimed to identify efficient strategies for initial islet autoantibody screening for childhood type 1 diabetes in children younger than 16 years.

The findings from the 5 prospective cohorts suggested screening at ages 2 years and 6 years old is efficient and sensitive to use on a larger scale.

“Our results show that initial screening for islet autoantibodies at two ages (2 years and 6 years) is sensitive and efficient for public health translation but might require adjustment by country on the basis of population-specific disease characteristics,” wrote study author William Hagopian, MD, PhD, Pacific Northwest Research Institute.

The early prediction of childhood type 1 diabetes can reduce ketoacidosis at diagnosis and may provide an opportunity for disease prevention. Despite this, Hagopian and the team of investigators noted that only highly efficient approaches are likely to succeed in public health settings.

They utilized data from the 5 prospective cohorts. These included Finland (DIPP), Germany (BABYDIAB), Sweden (DiPiS), and the USA (DAISY and DEW-IT) into the Type 1 Diabetes Intelligence (T1DI) cohort.

A total of 24,662 children at high risk of diabetes enrolled before age 2 years were included in the study and followed up for islet autoantibodies and diabetes until age 15 years, or type 1 diabetes onset, depending on whichever occurred first. The islet autoantibodies measured included those against glutamic acid decarboxylase, insulinoma antigen 2, and insulin.

Study outcomes were considered the sensitivity and positive predictive value or detected islet autoantibodies, tested at fixed ages, for the diagnosis of clinical type 1 diabetes.

A total of 24,662 participants were enrolled in the Type 1 Diabetes Intelligence cohort. From this population, 6722 participants were followed up until the age of 15 years or until onset of type 1 diabetes.

Data show type 1 diabetes developed by the age of 15 years in 672 children, but diabetes did not develop in a total of 6050 children. Investigators found optimal screening ages for 2 measurements were 2 years and 6 years, at a yielding sensitivity of 82% (95% confidence interval [CI], 79 - 86) and positive predictive value of 79% (95% CI, 75 - 80) for diabetes by the age of 15 years.

They found autoantibody positivity at the beginning of each test age had a high prediction of diagnosis in the subsequent 2 - 5.99 year or 6 to 15-year age intervals.

“Autoantibodies usually appeared before age 6 years even in children diagnosed with diabetes much later in childhood,” Hagopian added.

The study, “Two-age islet-autoantibody screening for childhood type 1 diabetes: a prospective cohort study,” was published in The Lancet Diabetes & Endocrinology.