[Predicting insulin-dependent diabetes. Study of risk markers]

The presence of specific antibodies at the time of clinical diagnosis, together with genetic susceptibility and animal models of spontaneous diabetes obtained by immunological destruction of insulin-secreting cells, suggests that insulin-dependent (type I) diabetes is an autoimmune disease. Prospective studies conducted among first-degree relatives of type I diabetes patients or in the general population have identified 3 types of markers appearing during subclinical destruction of islet cells, or pre-diabetes, which can be used to detect subjects at high risk. These are: high-titer anti-islet antibodies (ICA), anti-insulin autoantibodies and early insulin response to intravenous hyperglycaemia. Owing to the great heterogeneity of metabolic profiles, immunological markers alone cannot predict the time when insulin-dependence will occur. The psychological impact of these studies is such that they should be carried out only in specialized centres. Identifying pre-diabetes is important for the prevention of the disease. Until immunomodulators devoid of side-effects are available, pre-diabetes is a good period to train the patients and start insulin therapy when it becomes necessary.