Predicting type 1 diabetes using biomarkers.

Clinical type 1 diabetes is preceded by an asymptomatic phase that can be identified by serum islet autoantibodies. This perspective proposes that there is now sufficient evidence to allow a broader use of islet autoantibodies as biomarkers to diagnose type 1 diabetes that is already at an asymptomatic stage, so that attempts to prevent clinical hyperglycemia become a feature of disease management. Prediction would first, therefore, shift toward the use of genetic and other biomarkers to determine the likelihood that islet autoimmunity will develop in an infant, and second, toward metabolic assessment to stage and biomarkers to determine the rate of progression to hyperglycemia in children in whom islet autoimmunity is diagnosed. A case is presented for future comprehensive risk assessment that commences at birth and includes attempts to predict, stage, and prevent initiation and progression of the disease process at multiple stages. The biomarkers required achieving this level of sophistication and dissemination are discussed.