From a public health point of view, it would seem that screening for type 1 diabetes is the right thing to do, but some in the medical community have pointed out that screening tests have a low positive predictive value and that predicting the disease without a primary prevention capability raises ethical considerations because of induced stress, lifestyle changes, cost and potential effects on insurability. Additionally, they say, the lack of effective intervention programs to prevent the disease calls in the question of enacting any large-scale population screening.
The authors of “To Screen or Not to Screen for Type I Diabetes?” are Desmond Schatz MD, and Jin-Xiong She, both from the University of Florida in Gainsville; and Jeffrey Krischer, from the Lee Moffit Cancer Research Center and Research Institute, Tampa, Fla. Their findings are being presented at the 54th Annual Meeting of the American Association for Clinical Chemistry (AACC). AACC (http://www.aacc.org/) is the scientific organization for clinical laboratory professionals, physicians, and research scientists. Their primary commitment is the understanding of laboratory testing to identify, monitor and treat human disease. More than 11,000 attendees are expected for the meeting, which is being held at the Orange County Convention Center, Orlando, Fla., July 28-August 1, 2002.
Dr. Schatz suggests that there are important reasons to screen for the disease before symptoms arise:
1. To improve understanding of the natural history of the prediabetic period: The ability to prevent this disease has been enhanced by unraveling its genetic causes and consequently, the at-risk patients most susceptible. Three to six percent of first degree relatives of type 1 patients will develop the disease themselves (siblings are at the most risk).
2. To gain further insights into the immunopathogenesis of the disease: The cause of type 1 diabetes is believed to be caused by the interaction of genes, the environment, and the immune system. But when and how the disease actually starts remains unknown. The researchers suggest that early screening would permit an assessment of how such factors as cow’s milk might trigger disease onset.
3. Make an earlier diagnosis of type 1 disease: Ten to 40 percent of newly diagnosed type 1 patients present with ketoacidosis (decreased pH and bicarbonate concentration in the body fluids caused by accumulation of ketone bodies in diabetes mellitus), a condition that can lead to increased hospitalizations and mortality. Earlier identification provides an opportunity for more effective disease management, healthier patients, and less expensive medical costs.
4. Identify individuals for prevention trials: Current studies on ongoing worldwide, with American researchers partnering in numerous clinical trials. Recruiting volunteer subjects for these efforts is an essential and vital component of any research effort. The researchers conclude that screening in the context of well-designed research studies must continue. Once a safe and efficient intervention program is designed, say the researchers, screening could begin on a large scale basis.
Editor’s Note: To interview Dr. Schatz, please contact Donna Krupa at 703.527.7357 (direct dial), 703.967.2751 (cell) or djkrupa1@aol.com.
Or contact the AACC Newsroom at: 407.685.4215.