Dr Ezio Bonifacio Explains When to Begin Monitoring for T1D in Children

Ezio Bonifacio, PhD, discusses the optimal time to begin monitoring for type 1 diabetes (T1D) in children genetically at risk for the disease.

Around 1 year of age is a good time to begin monitoring for type 1 diabetes (T1D) among those at risk, said Ezio Bonifacio, PhD, a professor of diabetes and preclinical stem cell work at the Technical University of Dresden, in Germany. Bonifacio's talk "Determining Genetic Risk" for T1D was presented at the American Diabetes Association's 81st Scientific Sessions.


Can you introduce yourself and describe the work you do?

I'm Ezio Bonifacio. I'm a professor of diabetes, preclinical stem cell work at the Technical University of Dresden, in Germany. My main line of work is type 1 diabetes and its pathogenesis and its prevention. Part of that is also understanding the genetics of T1D and how we can use the data generated so far to help us in prevention of T1D.

For children at risk of developing T1D, how early should monitoring begin? Is there a test that a baby from a family with risk factors can be given to determine if monitoring should begin immediately?

It's a process. The process, all children who develop T1D will have a genetic susceptibility. That's something we can identify already at birth, obviously. The background risk for T1D is something around 3 or 4 per 1000 births. It's reasonable, but to find them, one would need to do some genetic typing. We are lucky in T1D, we being the researchers, in that there is a strong region of the chromosome that confers susceptibility or confers strong susceptibility, and that is the HLA region. We can combine that with lots of other genes, because there's a lot of genes out there that confer some susceptibility, and we can come up with a score.

What we can do already at birth is to identify those children who don't have a T1D, family history, but who actually have around 10% risk of getting the disease. So we go from 3 or 4 per 1000 to 100 per 1000 risk. That's at birth. That doesn't mean that they will get it, only 10% of those children will get it. It's also, to be fair here, with such a test, we're not going to pick up everybody who gets diabetes. In fact, we're only going to pick up less than half of those who will get diabetes. That's what we do at birth.

Monitoring requires something else. Again, we're lucky as researchers because the children will develop autoantibodies before they develop diabetes. That's a very good sign that they will develop [diabetes]. We don't know when yet. But we know that this starts somewhere around 6, 7, 8, 9 months of age. That's why we suggest, around about 1 year, starting around about age 1 year is a good time to start monitoring for these antibodies in people who are genetically at risk.