My four year old daughter tested negative for islet cell antibodies. What is the predictive value of this test for the future onset of type 1 diabetes?

At the present it is not possible to answer your question with any degree of precision. However, in an ongoing national study called DAISY (Diabetes and AutoImmune Syndromes in Youth), it has been shown that a small proportion of children who have first degree relatives with known type 1A (autoimmune) diabetes may not develop positive antibody tests and subsequent clinical diabetes until their preteen and teen years.

In view of this, you might consider re-testing you daughter when she is 12 by which time some of the major ongoing studies like ENDIT and DPT-1 may have shown that nicotinamide, oral insulin and a variety of other agents can indeed avert insulin dependance. If you are still anxious about diabetes, you might want to ask about HLA testing, not so much with the objective of finding alleles that increased the risk, but more in the hope of finding a ‘protective’ one which would make diabetes very unlikely indeed.

DOB