On the road to universal screening for risk of type 1 diabetes.
On the road to universal screening for risk of type 1 diabetes.
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DOI：
10.1016/s2213-8587(22)00166-8
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发表时间：
2022-08
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Mohamed Ghalwash及其同事1试图确定胰岛自身抗体筛查的最佳年龄，以预测15岁时临床1型糖尿病的发展。作者结合了5个出生队列（来自芬兰的DIPP队列、瑞典的DiPiS队列、美国科罗拉多的DAISY队列、美国华盛顿的DEW-IT队列和德国的BABYDIAB队列），共计约25000名1型糖尿病风险儿童。该分析集中在这些参与者中的近7000人，他们被随访至15岁，或在约10%的病例中发展为临床1型糖尿病。其余随访时间较短的儿童的数据用于通过应用逆概率删失加权（一种考虑右删失结局的方法）减轻非随机失访引起的潜在偏倚。研究样本和可用数据的相对同质性允许五项研究的协调，由此产生的大规模合并数据集是分析的优势之一。胰岛素、GAD 65和IA-2的自身抗体在几个不同的时间点进行了检测，这项研究的主要新发现是，在2岁和6岁时检测胰岛自身抗体对15岁时的糖尿病具有最高的敏感性（82%）和阳性预测值（79%）。也就是说，作者提出的自身抗体筛查策略确定了82%在15岁时发展为1型糖尿病的个体，79%被确定为自身抗体阳性的参与者最终发展为疾病。该性能对于筛选策略似乎是可接受的，其中
Mohamed Ghalwash and colleagues1 sought to determine the optimal age or ages for islet-autoantibody screening to predict the development of clinical type 1 diabetes by 15 years of age. The authors combined five birth cohorts (from the DIPP cohort in Finland, DiPiS cohort in Sweden, DAISY cohort in Colorado, USA, DEW-IT cohort in Washington, USA, and BABYDIAB cohort in Germany) with a total of approximately 25 000 children at risk for type 1 diabetes. The analysis focused on almost 7000 of these participants, who had been followed up to age 15 years or, in about 10% of the cases, developed clinical type 1 diabetes. Data from the remaining children, with shorter follow-up, were used to mitigate the potential bias caused by non-random loss of follow-up, by applying inverse probability censoring weighting, a method that accounts for right-censored outcomes. The relative homogeneity of the study samples and available data allowed harmonisation of the five studies, and the resulting large size of the combined dataset is one of the strengths of the analysis. Autoantibodies to insulin, GAD65, and IA-2 were tested at several, varying timepoints.The major novel finding in this study is that testing for islet autoantibodies at 2 years and 6 years of age had the highest sensitivity (82%) and positive predictive value (79%) for diabetes by age 15 years. That is, 82% of the individuals who developed type 1 diabetes by age 15 years were identified by the autoantibody screening strategy proposed by the authors, and 79% of the participants identified as being autoantibody positive ultimately developed the disease. This performance seems acceptable for a screening strategy, in which