Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation

Abstract

Aims/hypothesis We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. Methods Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. Results At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. Conclusions/interpretation Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes. Graphical Abstract

Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50‐year, single‐center experience

“…88 Several studies showed the incidence of DKA at diagnosis decreased over time due to the increased awareness of families and clinicians. 96 However, in some populations, similar to the current study, it has been shown that the frequency of DKA does not decrease over time. In a study from Austria, there was no change in the frequency of admission with DKA in the last 20 years.…”

Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

“…The Fr1da study has shown that early staging of type 1 diabetes in childhood is feasible and leads to a reduction in DKA incidence. 7,28,31 GPPAD is the Global Platform for the Prevention of Autoimmune Diabetes that was established in 2015 with the intention to establish an infrastructure for primary prevention trials in type 1 diabetes and that currently includes five European countries. [32][33][34][35] The Innovative approach towards understanding and arresting type 1 diabetes (INNODIA) consortium was established through the Horizon 2020 initiative of the European Union in 2015 (https://www.innodia.eu/) with the purpose of developing a European infrastructure for the recruitment, detailed clinical phenotyping and bio sampling of a large cohort of newly diagnosed individuals with type 1 diabetes and unaffected family members using the INNODIA Master protocol, generating a bio resource for type 1 diabetes discovery science.…”

“…Whilst the incidence of DKA in newly diagnosed type 1 diabetes has remained unacceptably high in recent years, 22,23 screening programmes have recently shown to be successful in reducing the incidence of DKA at diagnosis. [24][25][26][27][28] We are now entering a new era where disease-modifying therapies are becoming part of the therapeutic arsenal of type 1 diabetes.…”

General population screening for type 1 diabetes using islet autoantibodies at the preschool vaccination visit: a proof-of-concept study (the T1Early study)

“…This typically requires hospitalization, and causes psychological and physiological morbidity (4)(5)(6). Screening programmes measuring IAbs significantly reduce rates of DKA at diagnosis (7,8), hospitalization (9), and the presenting level of glycaemia (10,11).…”

“…Adopting population screening for T1D requires a universal approach, since the majority (>85%) of children do not have a relative affected. It has been suggested that the optimal age to test for IAbs at a single time point is between 3 to 5 years (8, 10, 11), since peak IAb development occurs between 9 months and 2 years (2). Our aim was to explore, as a ‘proof-of-concept’ study, general population screening for IAbs, in children attending their routine pre-school vaccination in primary care.…”