OPPORTUNITIES IN GENETICS
Researchers are using now designing advanced prediction and prevention studies that seek to attack type 1 diabetes before it begins.

It is hoped that the next phase of prediction studies will allow the identification of individuals susceptible to type 1 diabetes from the general population (i.e., those without a family history). Then, all at-risk individuals can benefit from trials to prevent type 1 diabetes before it develops, or at least be educated on the symptoms of the disease so medical care can be sought earlier upon onset of the disease.

Importantly, new prediction tests must be designed that are simple, practical, and cost-effective for widespread use in the general population. Such tests would ultimately allow early enrollment in prevention studies or early treatment of at-risk infants.

The list of potential environmental triggers for type 1 diabetes is large and includes diverse agents such as cow's milk, timing of the introduction of cereal in an infant's diet, vitamin D, viral infection, and more. Definitive identification of environmental triggers for type 1 diabetes would aid in the discovery of new drugs or behavior modifications — such as delayed use of infant cereal — that could reduce disease risk.

The ultimate goal for type 1 diabetes prevention may involve the development of a vaccine against a diabetes-specific trigger that would provide universal protection from the disease. This would allow eradication of type 1 diabetes over time, similar to the concept of eradicating infectious diseases such as poliomyelitis.

BENEFITS OF THIS RESEARCH
Prevention is the only true means of eradicating type 1 diabetes in the entire U.S. population. Preventing the disease would free up to 30,000 individuals per year from a lifetime of difficult, daily disease management and the risk of long-term complications such as blindness, limb amputation, and kidney failure. Over time, up to 5-10% of the total diabetes cases in the U.S. could be eliminated if a safe and effective type 1 diabetes vaccine were available. Society would benefit from the substantial savings in the healthcare costs treating type 1 diabetes and its complications, which can be more than twice as high as medical care for non-diabetic individuals. The CDC has estimated that the annual healthcare costs for an individual with diabetes is $11,744, compared with $5,095 for someone without diabetes.

Identifying the genetic and environmental causes of type 1 diabetes requires long term investment in large, collaborative, multi-year research projects. By the end of 2007, the Type 1 Diabetes Genetics Consortium is expected to have collected DNA samples from 2,800 families around the world that have two or more siblings with type 1 diabetes. Likewise, The Environmental Determinants of Diabetes in Youth (TEDDY) study is in the process of recruiting more than 7,000 infants who are at high risk of developing type 1 diabetes. Subject recruitment for these studies will be complete by the end of 2008. However, processing and analyzing these massive biological sample collections will require significant time, funds, and collaborative effort over the ensuing years. Substantial resources will be required until the projected end of the TEDDY study in 2021 to carefully monitor and study these children through the age of 15 years and identify environmental triggers associated with the development of type 1 diabetes.

For these reasons, funding needs for research related to identifying genetic and environmental causes of type 1 will increase moderately over the next several years so that the investment in genetic and environmental research can be fully realized.