“…Single screening at the age of 10 years was 90% sensitive, with a positive predictive value of 66% for clinical diabetes. Screening at two ages (10 years and 14 years) increased sensitivity to 93%, but lowered the positive predictive value to 55% [22]. These studies not only demonstrate that screening programs for T1D are possible, but they also may reduce the clinical burden of ketoacidosis (DKA) thanks to an earlier diagnosis.…”
Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.
“…Single screening at the age of 10 years was 90% sensitive, with a positive predictive value of 66% for clinical diabetes. Screening at two ages (10 years and 14 years) increased sensitivity to 93%, but lowered the positive predictive value to 55% [22]. These studies not only demonstrate that screening programs for T1D are possible, but they also may reduce the clinical burden of ketoacidosis (DKA) thanks to an earlier diagnosis.…”
Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.
“…A recent study determined that single screening adolescents with an increased risk of developing T1D for diabetes-related autoantibodies was effective, as the positive predictive value for detecting clinical diabetes by the age of 18 was 66% (95% CI, 60–72%). 29 Therefore, one can conclude that if the suggested initial screening window of 2 to 6 years is missed, any time thereafter is a good time to initially screen children who providers feel are appropriate candidates.…”
Section: Screening For Diabetes-related Autoantibodiesmentioning
Section: Screening For Diabetes-related Autoantibodiesmentioning
confidence: 99%
“…However, rescreening for diabetes-related autoantibodies in individuals with a family history of T1D (or other potential risk factors, including family/personal history of another autoimmune diseases) is advised because diabetes-related autoantibodies can develop later in life, especially when the initial screening is done as a young child. 29 If pediatric patients without family history of T1D or a history of other autoimmune diseases are initially screened between the ages of 2 and 6 years and test negative, it is reasonable to repeat screening at 10 years to capture a potential diagnosis within the peripubertal years. 11 , 29 , 32 Rescreening should be performed at any time if symptoms of hyperglycemia develop.…”
Section: Screening For Diabetes-related Autoantibodiesmentioning
Type 1 diabetes (T1D) is a complex, chronic autoimmune disease that affects over 1.6 million people in the United States. It is now understood that T1D may be undetected for many years while the disease progresses quietly without producing symptoms. T1D can be identified through diabetes-related autoantibody screening and staged accordingly, enabling healthcare providers to identify high-risk individuals in the early stages of the disease and either provide a stage-specific intervention or offer clinical trial opportunities to preserve beta cell function and anticipate the onset of clinical T1D. Evidence-based clinical practice guidelines currently do not exist for routine diabetes-related autoantibody screening of individuals at risk of developing T1D or of the general population. The purpose of this article is to help clinicians acquire an understanding of the rationale and protocols recommended for identifying patients at risk of developing T1D and monitoring such patients for autoimmune markers and progression of disease from Stage 1 to Stage 3 (clinical disease).
“…Thus, one frequent ("typical"?) phenotype of T1D could be the systematic discovery of mild hyperglycemia in a clinically asymptomatic individual, followed because of the presence of anti-beta cell autoimmunity on a high-risk genetic background [25].…”
The etiological diagnosis of diabetes conveys many practical consequences for the care of patients, and often of their families. However, a wide heterogeneity in the phenotypes of all diabetes subtypes, including Type 1 diabetes, Type 2 diabetes, and monogenic diabetes, has been reported and contributes to frequent misdiagnoses. The recently revised WHO classification of diabetes mellitus includes two new classes, namely “hybrid forms” and “unclassified diabetes”, which also reflect the difficulties of this etiological diagnosis. During the last years, many studies aiming at identifying homogenous subgroups on refined phenotypes have been reported. Ultimately, such subtyping may improve the diagnosis, prognosis, and treatment of patients on a pathophysiological basis. Here, we discuss the concepts of typical vs. atypical diabetes in the context of autoimmune Type 1 diabetes, Type 2 diabetes, and its monogenic forms. We discuss the contributions of clinical markers, biological tests, particularly islet cell auto-antibodies, and genetics to improving accurate diagnoses. These data support a systematic evaluation of all newly diagnosed diabetes cases.
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