Rationale:

• Because of the acute onset of symptoms, most cases are detected soon after symptoms develop.
• The incidence of type 1 diabetes is low, and screening healthy children would identify only small numbers of patients at great expense.
• Increased risk for type 1 diabetes is defined by a strong family history and the presence of genetic markers or serologic evidence of β-cell autoimmunity. There is no consensus on how to treat a patient with positive autoimmunity.

Evidence:

• Offspring of parents with type 1 diabetes and other first-degree relatives of probands have a low but increased risk of developing type 1 diabetes (1).
• Evidence of β-cell autoimmunity is found years before the clinical onset of hyperglycemia. β-cell decline is a progressive phenomenon that occurs over months to years before hyperglycemia (2; 3).

Comments:

• A risk score that predicts the development of type 1 diabetes in relatives of patients with type 1 diabetes has been developed (4). It is based on log-BMI, age, log-fasting C-peptide, and post-challenge glucose and C-peptide sums from 2-hour oral glucose tolerance tests and predicts the development of type 1 diabetes, which is important for future studies examining strategies for the prevention of type 1 diabetes. However, the use of such a risk score in clinical practice remains limited in the absence of any effective preventive treatment.