[Cost benefit of screening for type 1 diabetes. A futuristic scenario]

The current knowledge on prediction of Type 1 diabetes derives from family studies, as for example the BOX Study in England. Data indicate that first degree relatives with islet cells antibodies > or = 20 JDFu have a 35% risk to develop the disease within 5 years. But sensitivity and specificity of this risk marker are not high enough to allow for population screening. The tools for Type 1 diabetes screening in the background population are not known yet. Cohort studies have been initiated in different countries but the conclusions on the predictive value of risk markers are not ready. It is already established that both genetic and immunological markers will be necessary to identify individuals with an increased risk in the general population. Evaluation of cost/benefit ratio varies with the strategy for Type 1 diabetes screening. The ENDIT project can be taken as an example. It is an international trial using Nicotinamide for the prevention of the overt phase of Type 1 diabetes in high immunological risk individuals. To implement this model in first degree relatives is feasible and realistic and does not generate additional costs. Conversely the extension of this model to the background population raises many questions such as health structures, additional costs, budget and feasibility... This approach emphasizes the value and the need for epidemiological projects on risk factors of Type 1 diabetes, mainly in the background population, so that new strategies can be rapidly developed when the right preventive treatment is available.