Talking to Your Patients' Families about Diabetes Screening

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Riley Hospital for Children is part of Type 1 Diabetes TrialNet, an international network of clinical centers that are conducting research to learn more about how type 1 diabetes develops in people at risk for the disease. TrialNet's Natural History Study includes screening family members, ages 1 to 45, of people with type 1 diabetes. Here's what you need to know about the diabetes screening test.

Understanding the Importance of Diabetes Screening

Family members of people with type 1 diabetes have a 10- to 15-times greater risk of developing the disease than people with no family history of diabetes. Four percent of these family members have autoantibodies that are associated with a higher risk of developing type 1 diabetes. The presence of these autoantibodies — including ICA, GAD65, IAA and ICA512 — signal that a person's immune system might be attacking insulinproducing cells in the pancreas.

A simple blood test is used to determine the presence of these autoantibodies, which may appear years before a person develops type 1 diabetes.

The diabetes screening test represents the first of three phases of TrialNet's Natural History Study. The other phases include baseline risk assessment and follow-up risk assessment. Patients who complete the screening are not required to participate in other study phases.

Knowing Whom to Screen

The TrialNet study will screen family members of people with type 1 diabetes. It's important to note that family members of people with type 2 diabetes are not eligible for this diabetes screening test. To be eligible for this screening, family members must be:

• 1 to 45 years old and have a brother, sister, child or parent with type 1 diabetes, or
• 1 to 20 years old and have a cousin, aunt, uncle, niece, nephew, half-sibling or grandparent with type 1 diabetes.

Talking with Families about Diabetes Screening

Family members must give consent to have the blood test. Parents must give permission for children under 18. The screening involves drawing blood from an individual's arm and sending it to TrialNet's central laboratory for analysis.

You may refer families to Riley Hospital to complete the screening. Or, a family member may request a screening kit and have the blood test done at your office.

If a family member tests negative for the autoantibodies, he or she will receive a letter informing him or her of the results. If a family member tests positive, he or she will receive a call from a TrialNet health professional, who will discuss the results and next steps, including other testing options to determine more precisely the individual's risk of developing type 1 diabetes.

Participating in Diabetes Prevention Studies

Family members who test positive for autoantibodies may have an opportunity to enroll in the Natural History Study's surveillance phase. In addition, qualifying individuals may be eligible for enrollment in TrialNet's Diabetes Prevention Studies, which are designed to evaluate therapies that may prevent or delay the onset of type 1 diabetes.

Henry Rodriguez, MD
Associate Professor of Pediatrics Indiana University School of Medicine
Director, Pediatric Diabetes Clinical Program
Riley Hospital for Children
317-274-3889
hrodrigu@iupui.edu