PMID- 12662117
OWN - NLM
STAT- MEDLINE
DCOM- 20030722
LR  - 20181113
IS  - 1174-5878 (Print)
IS  - 1174-5878 (Linking)
VI  - 5
IP  - 4
DP  - 2003
TI  - Prediabetes in children: natural history, diagnosis, and preventive strategies.
PG  - 211-21
AB  - The clinical manifestation of type 1 diabetes mellitus is preceded by an 
      asymptomatic prodromal period called prediabetes or preclinical diabetes. It may 
      last from a few months to several years, during which the autoimmune destruction 
      of the insulin-producing beta-cells in the pancreas progresses. The genes on the 
      human leukocyte antigen (HLA) and insulin gene region are major genetic 
      determinants for genetic disease susceptibility, while dietary compounds and 
      viral infections are the most likely environmental factors contributing to the 
      etiopathogenesis. T cells are thought to be the effector cells for the beta-cell 
      destruction, and glutamic acid decarboxylase, insulinoma-associated protein 2 and 
      insulin represent the three major autoantigens. Autoantibodies are early 
      detectable markers of an ongoing disease process and are used to diagnose 
      prediabetes. Among first-degree relatives of patients with type 1 diabetes, the 
      risk for clinical disease can be graded from <5% in those with one or no 
      antibodies to >90% in individuals who carry the HLA-DQB1*02/0302 risk genotype 
      and are positive for multiple autoantibodies. beta-Cell function may also be 
      tested in autoantibody-positive individuals and low first-phase insulin response 
      is highly predictive for rapid progression to the clinical disease. However, 
      dynamic course and individual variation of the disease process complicates the 
      disease prediction, and it is not known whether all individuals with signs of 
      prediabetes will inevitably progress to clinical type 1 diabetes. Until 
      clinically applicable prevention for the condition exists, the screening for the 
      risk markers of type 1 diabetes should actively be undertaken only in the context 
      of research projects. Several major national and international multicenter 
      studies are ongoing to test the potential of various agents (e.g. insulin and 
      nicotinamide) or early elimination of dietary compounds (e.g. cow's milk 
      proteins) to delay or prevent the onset of clinical type 1 diabetes.
FAU - Kulmala, Petri
AU  - Kulmala P
AD  - Department of Pediatrics, University of Oulu, Oulu, Finland. petri.kumala@oulu.fi
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Switzerland
TA  - Paediatr Drugs
JT  - Paediatric drugs
JID - 100883685
SB  - IM
MH  - Child
MH  - *Diabetes Mellitus, Type 1/diagnosis/genetics/prevention & control
MH  - Genetic Predisposition to Disease
MH  - *Genetic Testing/economics/ethics
MH  - Humans
MH  - *Prediabetic State/diagnosis/genetics/prevention & control
RF  - 102
EDAT- 2003/03/29 05:00
MHDA- 2003/07/23 05:00
CRDT- 2003/03/29 05:00
PHST- 2003/03/29 05:00 [pubmed]
PHST- 2003/07/23 05:00 [medline]
PHST- 2003/03/29 05:00 [entrez]
AID - 541 [pii]
AID - 10.2165/00128072-200305040-00001 [doi]
PST - ppublish
SO  - Paediatr Drugs. 2003;5(4):211-21. doi: 10.2165/00128072-200305040-00001.