Clinical Characteristics of Children Diagnosed With Type 1 Diabetes Through Intensive Screening and Follow-Up

Abstract

OBJECTIVE -The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis. RESEARCH DESIGN AND METHODS -The Diabetes Autoimmunity Study in theYoung (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age-and sex-matched children concurrently diagnosed with diabetes in the community.RESULTS -Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P Ͻ 0.0001). They had a lower mean HbA 1c at onset (7.2 vs. 10.9%; P Ͻ 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P Ͻ 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U ⅐ kg Ϫ1 ⅐ day Ϫ1; P ϭ 0.003), 6 (0.37 vs. 0.58; P ϭ 0.001), and 12 months (0.57 vs. 0.72; P ϭ 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern.CONCLUSIONS -Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis. Diabetes Care 27:1399 -1404, 2004T ype 1 diabetes affects ϳ15-30 million people globally and 1.4 million in the U.S. (1,2). The incidence is increasing by 3-5% per year (3,4), especially among young children (5-9). Type 1 diabetes is responsible for significant morbidity, premature mortality (10), and financial burden (11). The disease usually is preceded by a preclinical period lasting months to years. Pre-diabetes can often be detected by the presence of autoantibodies to islet antigens such as GAD65, insulin, and IA-2 that are highly predictive of type 1 diabetes risk in children with (12) and without (13) a first-degree type 1 diabetic relative.In the absence of effective prevention, screening for pre-diabetes is currently not recommended outside of research studies. To date, interventions applied after the development of islet autoantibodies have been unsuccessful in slowing progression to diabetes (14,15). Several ongoing cohort studies (16 -19) follow high-risk children from birth to determine environmental triggers of type 1 diabetes. Interventions based on avoidance of these triggers before the onset of autoimmunity could be effective in preventing type 1 diabetes.One of these projects, Diabetes Autoimmunity Study in the Young (DAISY) (16,19), intensively follows two groups of children at increased risk for the development of diabetes: young first-degree relatives and infa...

Pediatricians' Attitudes Toward Expanding Newborn Screening

“…42 The CDC is currently funding 2 pilot screening studies, 1 in newborns and 1 at 6 months of age. We chose to include type 1 diabetes because 2 research pilot studies are on-going in the United States: Diabetes Autoimmunity Study in the Young (DAISY) in Colorado 43,44 and Prospective Assessment in Newborns for Diabetes Autoantibodies (PANDA) in Florida. 45 We chose to include fragile X because of interest within the fragile X community to develop newborn screening programs.…”

Cuadro clínico de inicio de la diabetes tipo 1 en el niño

“…Barker et al 11 , demostraron que el seguimiento de niños en alto riesgo de desarrollar diabetes reduce en más de diez veces la frecuencia de hospitalización y se asocia a una reducción significativa de la glicemia y la hemoglobina glicosilada al momento del diagnóstico, comparados con un grupo de niños con DM1 diagnosticada en un servicio clínico comunitario. Esta experiencia se basa en un complejo seguimiento de niños con predisposición genética y anticuerpos anti-islotes (+), poco repetible en la práctica clínica.…”

“…Se consideró que el paciente presentaba cetoacidosis cuando el pH era igual o menor de 7,3, el bicarbonato menor de 15,0 mmol/l y había cetonas en plasma 11,12 .…”

Newborn screening: new developments, new dilemmas

“…[16][17][18][19][20] We will apply the same ethical appraisal previously applied to standard newborn screening, and highlight differences between these new programmes and current practice, drawing firm conclusions about the ethical acceptability of new proposals.…”

“…25 Some benefits for children like Chloe may exist, in that childhood type 1 diabetes diagnosed through a screening and follow up programme has a less severe onset and a milder clinical course in the first year after diagnosis. 17 Nevertheless, lifelong insulin therapy is still required for these children, a fact not changed by susceptibility testing. Perhaps most tellingly, the majority of children identified as genetically susceptible will not develop diabetes and will consequently not benefit at all from screening or surveillance.…”