Psychological Impact of Islet Cell Antibody Screening

Galatzer, Avinoam; E, Green; Ofan, R; Benzaquen, Hadassa; Yosefsberg, Zeev; Weintrob, Naomi; Karp, Melvyn P.; Vardi, Pnina

doi:10.1515/jpem.2001.14.s1.675

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…Symptomatic adults with CD have been found to have poorer quality of life than asymptomatic patients at diagnosis; this improves only in symptomatic patients with either strict or partial adherence with a GFD after 1 year [92, 93]. Another study found no change in quality of life in screen-detected patients following a GFD [94]. A recent study in adolescents with CD aged 10–20 years observed worse quality of life in those not compliant with the GFD, with older teens experiencing more school and social problems than healthy teen controls [72].…”

Section: Wellbeing and Quality Of Lifementioning

confidence: 99%

Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Sud

Marcon

Assor

et al. 2010

International Journal of Pediatric Endocrinology

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Despite the advent of sensitive and specific serologic testing, routine screening for celiac disease (CD) in diabetic populations may not be universal practice, and many clinicians struggle to find the optimal approach to managing CD in pediatric Type 1 diabetes (T1D) patients. While some clinicians advocate screening for CD in all patients with T1D, others are unsure whether this is warranted. The diagnosis of patients who present with symptomatic CD, including malabsorption and obvious pathology upon biopsy, remains straightforward, with improvements noted on a gluten-free diet. Many patients identified by screening, however, tend to be asymptomatic. Evidence is inconclusive as to whether the benefits of screening and potentially treating asymptomatic individuals outweigh the harms of managing a population already burdened with a serious illness. This review focuses on current knowledge of CD in children and youth with T1D, highlighting important elements of the disease's pathophysiology, epidemiology, clinical presentation, and diagnostic challenges.

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Section: Wellbeing and Quality Of Lifementioning

confidence: 99%

Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Sud

Marcon

Assor

et al. 2010

International Journal of Pediatric Endocrinology

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“…The lack of diabetes in individuals who are autoantibody-positive may be either a function of time or may reflect autoimmunity that will never progress to diabetes. Knowledge of a positive islet autoantibody test likely has a psychological impact that varies over time and by individuals (32) and has been associated with behavioral change in an effort to prevent or delay the onset of disease (33).…”

Section: Insulin Dosementioning

confidence: 99%

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

et al. 2004

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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...

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“…Results of the BABYDIAB and TEDDY studies indicate that notification of a positive autoantibody test is associated with increased anxiety in parents that decreases over time (TEDDY unpublished data). [22][23][24][25] We expect training and counselling to reduce psychological stress. The psychological impact, depression, anxiety and burden are monitored using a standardised questionnaire (Patient Health Questionnaire 26 ) given on the diagnosis of pre-type 1 diabetes, and at 6 and 12 months later.…”

Section: Stress Assessmentmentioning

confidence: 99%

Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population: design and initial results of the Fr1da study

et al. 2016

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IntroductionType 1 diabetes can be diagnosed at an early presymptomatic stage by the detection of islet autoantibodies. The Fr1da study aims to assess whether early staging of type 1 diabetes (1) is feasible at a population-based level, (2) prevents severe metabolic decompensation observed at the clinical manifestation of type 1 diabetes and (3) reduces psychological distress through preventive teaching and care.Methods and analysisChildren aged 2–5 years in Bavaria, Germany, will be tested for the presence of multiple islet autoantibodies. Between February 2015 and December 2016, 100 000 children will be screened by primary care paediatricians. Islet autoantibodies are measured in capillary blood samples using a multiplex three-screen ELISA. Samples with ELISA results >97.5th centile are retested using reference radiobinding assays. A venous blood sample is also obtained to confirm the autoantibody status of children with at least two autoantibodies. Children with confirmed multiple islet autoantibodies are diagnosed with pre-type 1 diabetes. These children and their parents are invited to participate in an education and counselling programme at a local diabetes centre. Depression and anxiety, and burden of early diagnosis are also assessed.ResultsOf the 1027 Bavarian paediatricians, 39.3% are participating in the study. Overall, 26 760 children have been screened between February 2015 and November 2015. Capillary blood collection was sufficient in volume for islet autoantibody detection in 99.46% of the children. The remaining 0.54% had insufficient blood volume collected. Of the 26 760 capillary samples tested, 0.39% were positive for at least two islet autoantibodies.DiscussionStaging for early type 1 diabetes within a public health setting appears to be feasible. The study may set new standards for the early diagnosis of type 1 diabetes and education.Ethics disseminationThe study was approved by the ethics committee of Technische Universität München (Nr. 70/14).

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Psychological Impact of Islet Cell Antibody Screening

Cited by 11 publications

References 15 publications

Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

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

Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population: design and initial results of the Fr1da study

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