Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective

Abstract

Most screening programs to identify individuals at risk for type 1 diabetes have targeted relatives of people living with the disease to improve yield and feasibility. However, ∼90% of those who develop type 1 diabetes do not have a family history. Recent successes in disease-modifying therapies to impact the course of early-stage disease have ignited the consideration of the need for and feasibility of population screening to identify those at increased risk. Existing population screening programs rely on genetic or autoantibody screening, and these have yielded significant information about disease progression and approaches for timing for screening in clinical practice. At the March 2021 Type 1 Diabetes TrialNet Steering Committee meeting, a session was held in which ongoing efforts for screening in the general population were discussed. This report reviews the background of these efforts and the details of those programs. Additionally, we present hurdles that need to be addressed for successful implementation of population screening and provide initial recommendations for individuals with positive screens so that standardized guidelines for monitoring and follow-up can be established.

Precision medicine in type 1 diabetes

“…Identification of longitudinal biomarkers in the form of isletspecific autoantibodies in large studies of at-risk individuals (either from genetically high-risk infants from birth or firstdegree relatives of people with type 1 diabetes [19]) has increased our understanding of the progression to type 1 diabetes and improved the prediction of future type 1 diabetes development. Historically, the at-risk population was identified using HLA typing of type 1 diabetes risk-associated HLA alleles (HLA-DR3-DQ2 and/or HLA-DR4-DQ8, with avoidance of strong protective alleles such as HLA-DR15-DQ6) or by identifying infants or adults at risk because of an affected family member [20].…”

ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents

“…Screening for risk of T1D is gaining international momentum. While the majority of screening programs remain within the context of research trials, implementation science programs in Europe, the United States, and Australia are actively demonstrating feasibility and acceptability 29 . In time, screening is likely to be embedded in local, regional, and national health systems as the standard of care.…”

Typ-1-Diabetes Risikoscreening bei Neugeborenen und Studien zur Prävention des Typ-1-Diabetes

“…1 Übersicht aktueller internationaler Typ-1-Diabetesrisiko-Screening-Programme. GRS = Genetischer Risiko Score; AA = Autoantikörper (nach Sims E et al [20]).…”