Figure 1.

Key role of screening and monitoring relatives as standard of care to achieve the goal of T1D prevention. Prevention of T1D (green) will ultimately require both implementation of screening programs for the general population and that multiple options for disease-modifying therapy be available as part of standard of clinical care. This will be achieved by building on current accomplishments and interim steps. Current accomplishments (aqua): we currently identify those at risk through research studies (A) and have demonstrated that multiple therapies alter disease course after diagnosis (B), which has led to the demonstration that one therapy can delay T1D by >1 year (C). This conceptual goal has actually been exceeded, as the TrialNet teplizumab trial reported a delay in T1D by a median of 2 years (1). Interim future steps (dark blue): sustainable approaches to screening the general population, demonstrating that multiple therapies can delay T1D, and extending the duration of therapies delaying T1D are interim steps informed by current accomplishments (dotted lines). Key step (orange): screening and monitoring relatives as standard of care is a key step, as it will accelerate (1) development and eventual implementation of general population screening and (2) trial enrollment, and therefore approval for multiple therapies, which will provide the essential justification for screening the general population.