Testing To Identify Future Type 1 Diabetics

There is a lot of information in the news about obesity, metabolic syndrome, and diabetes these days. In many cases, these are related. But, Type 1 diabetes is an autoimmune disorder which attacks the body’s ability to make insulin. Currently, there is no way to prevent or cure Type 1 diabetes.

While it has long been called juvenile diabetes, the reality is that of the 30,000 new cases diagnosed each year, about ½ of them are in adults. The key question is whether you could screen for this. There is now a blood test which is being used at Type 1 Diabetes TrialNet (18 research centers conducting clinical trials) which can help physicians identify the onset of the disease as early as 10 years before symptoms.

Right now, people that qualify can get the test for free, but I think this brings into play the larger question. When is it appropriate and cost effective to screen people about future diseases? In today’s US healthcare model, the “churn” of membership often downplays the long-term public value of prevention. Unless you know a member will be with you in the future when these costs come to be, should you bear the costs of the test today?

A few stats from yesterday’s WSJ on this:

• 3 million Americans have Type 1 diabetes (compared to 22M who have Type 2)
• 80 people a day in the US that are diagnosed with Type 1 diabetes
• 3% annual increase in the Type 1 diabetes cases world-wide under the age of 14
• 11-14 is the peak age for Type 1 diagnoses

So, the key question is how do you know if you’re at risk…

The primary factor that was identified in the article was whether you have a family member with the disease. If yes, you’re 15x more likely to have Type 1 diabetes than the general population. Perhaps as part of an HRA (health risk assessment), we should be asking about Type 1 diabetes in the family and screening those that say yes. Or, we could look at medical or pharmacy claims and reach out to family members about being screened.