medwireNews: “Almost no one” who is islet autoantibody negative at age 10 years despite a high familial risk for type 1 diabetes will develop clinical diabetes by the age of 18, report researchers.
Riitta Veijola (Oulu University Hospital, Finland) and team found that the negative predictive value of autoantibody screening from the age of 10 years onward was at least 99%, regardless of the age at screening and whether children were screened once or twice.
“We believe that these results provide a pragmatic, efficient strategy for islet autoantibody screening that would facilitate prevention of diabetic ketoacidosis and recruitment of young people into new prevention trials,” they write in The Lancet Child & Adolescent Health.
The findings are based on data from 1890 children from the prospective DIPP, DAISY, DEW-IT, and BABYDIAB cohorts, 59.2% of whom had a family history of type 1 diabetes. The 23% who developed islet autoantibodies were a median age of 7.1 years when this was first detected, and the 14% who developed clinical diabetes did so at a median age of 12.6 years.
The team calculated that if autoantibody screening were performed just once, the optimal age would be 10 years, which gave a sensitivity of 63% and positive predictive value of 38% in the whole study population and a corresponding 90% and 60% when restricted to children who completed all testing and observation.
In this latter subgroup, adding a second screening point at age 14 years increased the sensitivity “only marginally” to 93% but reduced the positive predictive value to 55%, say the researchers.
“Given that the cost of two-age screening is twice that of a single screening, we consider a single screening at 10 years of age a good choice,” they say.
Veijola and team point to their previous work showing that screening at the ages of 2 and 6 years identifies most children who develop diabetes before the age of 15.
The latest analysis “provides a framework for screening of older children and adolescents,” they say, highlighting that the highest risk for diabetic ketoacidosis at diagnosis occurs in very young children but also in adolescents.
In a linked commentary, Olga Kordonouri and co-authors from Auf der Bult Children’s Hospital in Hannover, Germany, emphasize the high negative predictive value of autoantibody screening, saying that the finding “is reassuring and would relieve anxiety, especially in families with a history of type 1 diabetes.”
They add that the recent US approval of teplizumab for slowing the onset of clinical type 1 diabetes in high-risk individuals may increase the perceived value of screening programs and spur their initiation to facilitate timely intervention with this medication.
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Lancet Child Adolesc Health 2023; doi:10.1016/S2352-4642(22)00350-9
Lancet Child Adolesc Health 2023; doi:10.1016/S2352-4642(23)00001-9