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Helmholtz Munich I Daniela Barreto

Population-Wide Screening for Early-Stage Type 1 Diabetes in Children: Opportunities and Challenges in Pediatric Care

Featured Publication, Diabetes, IDF,

The diagnosis of type 1 diabetes often comes with serious complications for families, as the autoimmune disease is frequently detected only after severe symptoms develop. Early detection of type 1 diabetes through population-wide screening offers numerous benefits for children and adolescents diagnosed with this condition. A recent study has modeled the impact of population-wide screening for pre-symptomatic type 1 diabetes on pediatric clinical care. The findings of the study, conducted by researchers from Helmholtz Munich and the Technical University of Dresden, were published in The Lancet Diabetes & Endocrinology and supported by the Deutscher Diabetiker Bund e.V..

Patients benefit from early detection of type 1 diabetes

Type 1 diabetes is an autoimmune disease caused by the body's immune system attacking the insulin-producing beta cells of the pancreas, resulting in a dependency on external insulin. If diagnosed and treated too late, severe complications such as diabetic ketoacidosis (DKA) can occur. Previous studies suggest that preventing diabetic ketoacidosis at the start of the disease can improve the long-term clinical prognosis. Screening programs, such as the Fr1da study led by Helmholtz Munich, test for islet autoantibodies in the general population to identify children with early-stage type 1 diabetes before symptoms develop. Islet autoantibodies in the blood serve as biomarkers for early-stage type 1 diabetes. The presence of two or more of these autoantibodies indicates an autoimmune response against the insulin-producing cells in the pancreas.

Population-wide screening could increase the number of children in clinical care for type 1 diabetes by 60 percent

The Fr1da study has demonstrated that screening is feasible and accepted by families and healthcare providers. However, population-wide screening requires additional healthcare resources. In their new study, the researchers estimate that the number of children in pediatric care for type 1 diabetes could increase by 60 percent within the next 10 to 20 years if a population-wide screening for early-stage type 1 diabetes was implemented. Families will require follow-up care for counseling and monitoring the disease progression, which will incur additional healthcare costs. The researchers based their model on data from the Fr1da study, which screened over 195,000 children from 2015 in four regions of Germany.

A reduction of long-term healthcare expenses could compensate additional costs

Children with early-stage type 1 diabetes would necessitate follow-up pediatric care, which currently consists of random plasma glucose measurements, biannual HbA1c measurements, and less frequent oral glucose tolerance tests or continuous glucose monitoring for an average duration of 6 years before progressing to clinical diabetes. This requires additional resources. In return, the researchers predict that there will be a substantial reduction in care costs associated with diabetic ketoacidosis and hospitalization days. Furthermore, starting the disease without severe complications could improve long-term diabetes management and disease progression, which might further reduce expenses.

European action for the Diagnosis of Early Non-clinical Type 1 diabetes (EDENT1FI)

Within the next years, the EDENT1FI consortium wants to improve the availability and acceptance of autoantibody screening across Europe. This global collaboration between academia, industry, and funders seeks to combat type 1 diabetes at the pre-clinical stage. Programs like EDENT1FI are needed to develop nationwide and international strategies for improving access to and acceptance of early-stage type 1 diabetes screening in several European countries.


Original publication

Bonifacio et al., 2024: Effect of population-wide screening for presymptomatic early-stage type 1 diabetes on paediatric clinical care (2024). The Lancet Diabetes & Endocrinology. DOI: 10.1016/S2213-8587(24)00101-3