How to identify patients at high risk for type 1 diabetes

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It is clear that type 1 diabetes results from a chronic autoimmune process that results in destruction of the pancreatic islet cells. An important question is whether patients at particularly high risk of developing type 1 diabetes can be identified prospectively. This would be helpful for clinical trials designed to test strategies for preventing the ultimate development of diabetes.

In this issue of The Journal, Barker et al evaluated subjects in the Diabetes Prevention Trial Type 1. These were first and second degree relatives of individuals who had diabetes and who had ICA auto-antibodies. Subjects also had an intravenous glucose tolerance test (IVGTT) and an oral glucose tolerance test (OGTT). The results show that most subjects who subsequently developed diabetes had an abnormal IVGTT and/or OGTT. The highest sensitivity to detect those at highest risk of diabetes was achieved using both tests. These results are probably not useful from a clinical standpoint at this time because there is no current method of prevention. However, it will allow more efficient future studies directed at preventive strategies.