Progression from single to multiple islet autoantibodies often occurs soon after seroconversion: implications for early screening

Excerpt

To the Editor: Multiple islet autoantibodies mark a pre-clinical stage of type 1 diabetes, with 70% progression to clinical diabetes within 10 years of seroconversion [1]. Broad application of screening for multiple islet autoantibodies may, therefore, become an attractive instrument to identify asymptomatic type 1 diabetes and prevent severe metabolic disarrangements and ketoacidosis. In contrast to multiple islet autoantibodies, only a minority of children who are, and remain, single islet autoantibody-positive develop type 1 diabetes within 10 years of follow-up. Nevertheless, many multiple islet autoantibody-positive children are likely to have transitioned from single to multiple islet autoantibodies. We [2, 3], and others [4] have reported that multiple islet autoantibody-positive children frequently seroconvert in the first 2 years of life, but little is known of the timing of transition from single to multiple islet autoantibody positivity. This knowledge is important for the design of screening and re-screening strategies. Here we analysed the prospectively followed German BABYDIAB/BABYDIET birth cohort [2, 5] to address this. …