Understanding the Risk of Type 1 Diabetes
For decades, studies have been conducted in “Westernised” countries to understand the risk of type 1 diabetes. These studies have focused on high-risk populations, such as relatives of those with the condition.
- Bart’s Oxford Study: Started in the UK in 1985, this study recruited over 5,000 families to assess the risk of type 1 diabetes in children.
- Other Key Studies: Over the next decade, important birth cohort studies, including BABYDIAB (Germany), DIPP (Finland), and DAISY (US), were launched.
- Key Finding: A combined analysis of these studies in 2013 showed that children with two or more islet autoantibodies have an 83% risk of developing type 1 diabetes by the age of 20.
- TEDDY Study: Set up in 2024, this study aims to screen and follow 15,000 children in the USA and Europe who are at high genetic risk to understand the role of environmental factors in the disease’s development.
- TrialNet: Since 2004, this network has offered screening for relatives of people with type 1 diabetes up to age 45 and runs clinical trials for new treatments. A TrialNet study showed that the drug Teplizumab could delay the onset of the condition.
Staging Pre-Type 1 Diabetes
In 2016, a staging system was introduced to standardise the period before symptoms appear.
- Stage 1: Two or more islet autoantibodies are present, but blood sugar levels are normal and there are no symptoms.
- Stage 2: Two or more islet autoantibodies are present, along with slightly higher than normal blood sugar levels (dysglycemia), but there are still no symptoms.
- Stage 3: The person has reached the point of being diagnosed with type 1 diabetes, which may occur with or without symptoms.
Studies in the General Population
More recent research has started to look at the general population, not just those at high risk.
- Children:
- Fr1DA Study (Germany): This was the first study of its kind, screening over 90,000 children. It found that 0.3% of children had presymptomatic type 1 diabetes.
- EDENT1FI Study: Launched in 2023, this study aims to screen 200,000 children across Europe, including the UK.
- ELSA Study (UK): Started in 2022, this study is checking how practical and acceptable it is to screen children for type 1 diabetes.
- Adults:
- In 2023, the University of Bristol team launched the world’s first natural history study of type 1 diabetes in the general adult population, called T1DRA.
- The study aims to recruit 20,000 adults aged 18 to 70 to find out how many have pre-symptomatic type 1 diabetes in the UK.
- This research hopes to answer important questions, such as the lifetime risk of developing symptoms for adults with autoantibodies and whether the current staging system works for adults.