Diabetes Prevention in Skåne
The DiPiS study is prospective study that involved screening of all newborn infants in Scania (Skåne) county in southern Sweden for risk factors of Type 1 Diabetes (T1D). The study aims at identifying infants and children in Skåne who are genetically susceptible to T1D (having high risk HLA genes) and to follow these children for 15 years to monitor if they will develop markers of islet autoimmunity (islet autoantibodies) and T1D. The study was implemented in two stages; stage I started in September 2000 and ended in September 2004. This stage involved an attempt to recruit all newborn children during these four years (about 45,000) and test them for HLA risk. It was possible in Step I to obtain cord blood samples from more than 36,000 newborn children representing 80% of all children born alive.
Stage II represents a longitudinal follow up of children with increased genetic risk for T1D. HLA was used as the primary risk factor (HLA-DQ 2, 8, or both) but children with islet autoantibodies in the cord blood as well as children born in families with first-degree relatives were included as well. Almost 20% of the screened children were invited to participate in follow-up to determine environmental factors that may induce islet autoantibodies and T1D. Children with high risk to develop T1D were invited to submit a blood sample from two years of age. A blood sample test kit with a questionnaire was mailed to the parents who were asked to bring the child to their Community Health Care Center (Vårdcentral) in order to get a blood sample from their child. Each year the child would give a blood sample for islet autoantibody testing and a specific questionnaire is filled by the parents. This yearly examination will allow identification of children who develop islet autoimmunity. Children with more than one islet autoantibody are contacted and referred for follow up four times per year by a specialist pediatrician in Malmö, Lund, Helsingborg, Kristianstad or Ystad.
In 2009, there is a cohort of more than 3,000 children who are actively participating in DiPiS. More than 100 children born during the DiPiS screening years have developed T1D. Currently, there are about 50 children in quarterly follow-up (more than one islet autoantibody) by a specialist pediatrician.
The main goal of DiPiS will not only be the identification of high-risk children to be closely monitored prior to clinical onset but also to enroll children with more than one islet autoantibody in prevention and intervention trials. One such trial to prevent T1D (DIAPREV-IT) is using the Alum-GAD vaccine (Diamyd) in islet autoantibody-positive children prior to the clinical onset. Diamyd® was shown to be highly safe and efficacious to preserve residual beta-cell function in newly diagnosed T1D children and teenagers.
Results and knowledge learned from the DiPiS study is expected to provide valuable information regarding the natural history of T1D and may boost efforts to prevent T1D.
Further information about the DiPiS study and locations for follow up and testing are available from the following links
DiPiS is supported by grants from Swedish Research Council, Swedish Diabetes Association, 7th FP EU grant DIAPREPP, Barndiabetesfonden, UMAS Funds, Skåne County Council for Research and Development and the European Foundation for the Study of Diabetes (EFSD).