Understanding the Risk of Developing Type 1 Diabetes

Dr. Fran Cogen Health Pro
  • Damocles was a courtier in the court of Dionysius II of Syracuse in 4th century BC. Unfortunately, Damocles, trying to curry favor, complemented Dionysius by noting that as a "great man of power, he was extremely fortunate." Dionysius offered to trade places with Damocles for a day. In the evening a banquet was held and while Damocles was enjoying the festivities, he noted that a sharpened sword was hanging directly over his head by single horsehair. He immediately lost all interest in the banquet and asked to take immediate leave from the tyrant, Dionysius. (Wikipedia)


    Cicero, the great philosopher, understood that this legend conveyed a sense of the constant fear in which the great man lived and asked:

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    "Does not Dionysius seem to have made it sufficiently clear that there can be nothing happy for the person over whom some fear always looms?" (Cicero, Tusculan Disputations 5.1.)


    The "Sword of Damocles" is thus used to denote the sense of foreboding that is triggered by a precarious situation, especially when the onset of tragedy is restrained by a delicate thread.


    You are probably asking how the "Prediction of Type 1 Diabetes" relates to the "Sword of Damocles?" The underlying subtext is "Do you want to know the risk of developing type 1 diabetes when at this current time we can do nothing to prevent its development?" ANSWER: It depends. Every family is different. Some families want to know everything and will research every possible source to become fully informed. Others do not wish to know this information for fear of the "knowledge of the possibility" or The Sword of Damocles.


    The recent paper in Diabetes Care 33: 1206-1212, 2010: Prediction of Type 1 Diabetes in the General Population addresses the risk of the development of type 1 diabetes in the general population as opposed to first degree relatives. The Finish authors, Knip et. al, evaluated the efficacy of GAD antibodies (GADAs) and islet antigen-2-antibodies (IA-2As) in predicting type 1 diabetes over a 27-year time frame in the general population and determined the 6-year rates of newly developed antibodies. 3,475 nondiabetic subjects (ages 3-18) were sampled for GADA and IA-2A in 1980. 2,375 subjects (68.3%) were retested in 1986. All subjects were observed for the onset of type 1 diabetes until the end of 2007. The results:

    1. 34 subjects initially had GADAs. 1% or 9 individuals developed diabetes.
    2. 22 subjects initially had IA-2As. 0.6% or 9 individuals developed diabetes.
    3. 7 subjects initially had both GADA's and IA-2As. 0.2% or 7 individuals developed diabetes.
    4. The positive seroconversion rate over 6 years was 0.4% for GADAs and 0.2% for IA-2As .
    5. 18 subjects or 0.5% developed type 1 diabetes after a median of 8.6 years.
    6. Initial positivity for GADAs and/or IA-2As had a sensitivity of 61% for type 1 diabetes.
    7. Combined positivity for GADAs and IA-2As had both specificity and a positive predictive value of 100%.


  • The authors conclude that one time screening for GADAs and IA-2As in the general population in Finland would identify approximately 60% of those individuals who will develop type 1 diabetes over the next 27 years. Most importantly, those subjects who have both autoantibodies carry an extremely high risk for diabetes.

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    Please keep in mind that Finland is in a latitude with a high incidence of type 1 diabetes. The next question is if it is worth doing universal screening for type 1 diabetes? If there is no cure at present? If we develop a cure?


    Diabetes teams offer the predictive TRIALNET for our families who already have one child or family member with diabetes. Not every family wishes to participate simply because knowing that a child or family member is at significant risk for type 1 diabetes does not mean that we can as of yet do anything to prevent it (apart from participating in research trials). Knowledge in this setting may not necessarily translate into psychological well-being. Or as Cicero might have said:


    "Is it sufficiently clear that there can be nothing happy for the person over whom some fear always looms?"


    I do not wish to conclude this piece on a negative note; but rather to reiterate that as soon as my fellow research colleagues identify a cure/treatment for this autoimmune disease, the above information will prove very positive in the ability to pinpoint who may develop type 1 diabetes, and then prevent it!




Published On: August 18, 2010