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There are different approaches for the identification of individuals at risk for T1D. These approaches are based on family history of T1D, genetic disease markers, autoimmune markers, or metabolic markers of T1D (Figure 2.2). These alternatives may also be combined in various ways to improve the predictive characteristics of the screening strategy. The importance of understanding the natural history of immune mediated pre‐diabetes lies in the development of prevention strategies. Several randomized clinical intervention trials have been concluded and the next generation of such trials will rely upon improved and simplified identification of individuals who are at high risk of progression to T1D. This is essential to ensure that trials have sufficient statistical power to detect a given effect of the intervention within the time available for the study. Such understanding is also needed to avoid exposing those who will not develop T1D to the risk of adverse effects of the intervention.

FIG 2.2 Strategies to preserve β‐cell mass in T1D. Modified from Reimann M, Bonifacio E, Solimena M et al. An update on preventive and regenerative therapies in diabetes mellitus. Pharmacol Ther 121(3): 317–331, 2009.