Identification of Infants With Increased Type 1 Diabetes Risk for Enrollment Into Primary Prevention Trials.

Type 1 diabetes is one of the most common chronic diseases of childhood, with incidence rates increasing worldwide. The disease is caused by immunemediated destruction of the insulin-producing beta cells of the pancreas, ultimately resulting in lifelong insulin deficiency. Before the clinical onset of type 1 diabetes, individuals often develop circulating autoantibodies against pancreatic beta-cell antigens, which are markers of loss of immune tolerance and early autoimmune activity. The development of type 1 diabetes is influenced by both genetic susceptibility and environmental factors. Although the risk of type 1 diabetes in the general European population is relatively low (approximately 0.4%), certain genetic profiles are associated with substantially increased risk. In particular, variants within the Human Leukocyte Antigen (HLA) region on chromosome 6, especially HLA DR and DQ haplotypes, represent the strongest known genetic determinants of disease susceptibility. Additional non-HLA genetic loci further contribute to risk stratification. Previous studies have demonstrated that newborns and infants at increased risk for developing beta-cell autoimmunity and type 1 diabetes can be identified through genetic screening. Infants with a first-degree relative affected by type 1 diabetes already have an estimated disease risk of approximately 5%. Among these individuals, the presence of specific HLA genotypes, including HLA DR4-DQ8 and HLA DR3/DR4-DQ8 combinations, is associated with further increased susceptibility. Incorporation of additional type 1 diabetes susceptibility markers allows identification of infants with a greater than 10% risk of developing multiple beta-cell autoantibodies during early childhood. This study aims to identify neonates and infants with increased genetic risk for type 1 diabetes through analysis of HLA and additional susceptibility markers. Genetic risk assessment will be used to identify participants who may be eligible for primary prevention clinical trials designed to prevent or delay the development of beta-cell autoimmunity and progression to type 1 diabetes.