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Newborns Screened For Risk Of Diabetes

Posted: Wednesday, September 08, 2004

Parents in parts of Georgia are among the first in the country able to discover whether their newborns have an elevated risk for type 1 diabetes.

The disease requires a lifelong dependence on insulin shots or pumps, and it can lead to blindness, kidney failure, amputation and other complications. Sometimes, the first symptoms can be fatal, when wayward cells suddenly break down fat, causing vomiting and abdominal pain often misdiagnosed as the flu.

Like type 2 diabetes, which normally occurs later in life and is often associated with obesity or inactivity, type 1 diabetes is on the rise. Scientists are not sure why, largely because they do not know what causes it.

Something in type 1 diabetics triggers the immune system to destroy cells in the pancreas that produce insulin, which regulates sugar in the blood. Genetics explain part of the picture. But diet, infections and possibly even today's relatively germ-free environment may have contributed to a spike in the disease in recent decades, researchers say. The rate appears to have increased by up to 3 percent a year.

To better understand the condition that affects about 1 million Americans, researchers are screening newborns to identify children most likely to acquire the disease and study them long before they get it. By looking at changes in blood proteins and surveying environmental factors — from breast-feeding to water supply to medications used during pregnancy — they hope to better predict who will get type 1 diabetes and learn what causes it and how to prevent it.

Three hospitals in Gainesville, Fla., are participating, along with three in Augusta. Northside Hospital in Atlanta — with 17,000 births a year, one of the highest tallies in the country — joined this summer. Others in Athens and in Aiken, S.C., are expected to follow soon.

The only other places in the United States that have offered newborn screening for diabetes are the state of Washington and a hospital in Denver. The testing is done for free on a research basis with parental consent.

For now, diabetes is not among the conditions for which babies are routinely screened. The list, mostly of metabolic disorders that can be offset by special diets, varies among states. Georgia tests for eight conditions and expects to soon add a ninth.
The test looks for mutations in two genes. A positive result means a child faces a 5 percent to 40 percent risk of developing type 1 diabetes, compared with a 0.4 percent risk in the general population. If children deemed at high risk are found in other tests to have certain antibodies, they have an 85 percent chance of getting it.

Other genes may soon be added to the test to refine the newborn screening, but results will still be murky. Since parents can't do anything to prevent the disease, Goldstein asks, why bother screening when the results aren't more certain?

"We would all like to do newborn screening eventually, but there's a lot of stuff to overcome," he said. "It's probably five or 10 years away, not one or two."

The Atlanta-based Centers for Disease Control and Prevention is working with state labs to prepare for the possibility of universal screening, said Robert Vogt, a CDC lab scientist.

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