Type 1 diabetes is the most common autoimmune disease in children and adolescents. Children with a genetic predisposition are exposed to environmental factors that cause an immune response against their own pancreatic β cells, i.e., the immune system attacks and damages the β cells, resulting in a significant decrease in insulin secretion and a significant increase in blood glucose, and the child needs insulin injections to stay alive.
Type 1 diabetes is difficult to control and requires multiple daily injections of mealtime and basal insulin or insulin pump therapy, and there are also multiple treatments such as stem cell transplantation and islet transplantation, but each is not perfect and there is no cure for type 1 diabetes. Therefore, it is very important to prevent the development of type 1 diabetes in this situation.
The development of type 1 diabetes is associated with a number of risk factors, such as a family history of type 1 diabetes, HLA-II class I genes, 4 islet cell-associated antibodies, and abnormal glucose tolerance, and people with these factors are predisposed to type 1 diabetes.
Genetic factors
Type 1 diabetes has a genetic predisposition associated with more than 40 genes, most notably the human leukocyte antigen (HLA) gene, and HLA-II class genes are now available for type 1 diabetes prediction. Also, people with a family history of type 1 diabetes are more likely to have the disease than the general population, but not absolutely.
Islet cell-associated antibodies
Type 1 diabetes is an autoimmune disease, and the autoantibodies associated with it are insulin antibodies, glutamic acid decarboxylase antibodies, protein tyrosine phosphatase antibodies, and zinc transporter 8 autoantibodies.
The detection of these four antibodies is of great value in the prediction of type 1 diabetes. In addition, the risk of developing diabetes is closely related to the number of positive antibodies, with the higher the number of positive antibodies, the higher the risk of developing diabetes, and the incidence of individuals with 2 or more positive antibodies is almost 100%.
However, another 10% to 15% of people with type 1 diabetes are consistently negative for autoantibodies, suggesting that there may be other islet autoantibodies that are not identified. In addition, the age of onset of type 1 diabetes is associated with the age of first positive antibody and the titer of insulin antibodies.
In conclusion, the number of positive autoantibodies, the age of first antibody positivity, and the titer of insulin antibodies are all predictive of the onset of type 1 diabetes.
Abnormal glucose tolerance
The natural course of type 1 diabetes shows that pancreatic islet β-cell decompensation is slow and progressive, with abnormal glucose metabolism present 1-2 years before the diagnosis of type 1 diabetes. So, regular glucose tolerance testing can detect type 1 diabetes early.
In summary, people with one or more risk factors are more likely to have type 1 diabetes. Therefore, regular screening can detect and confirm type 1 diabetes early, take early steps to prevent and treat it, and try to stop or delay the onset and progression of type 1 diabetes.