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Diabetes in Children Early Detection Tests for a World Without Type 1 Diabetes

At Helmholtz Munich, scientists are working to ensure that no child will have to suffer from the autoimmune disease type 1 diabetes in the future.

At Helmholtz Munich, scientists are working to ensure that no child will have to suffer from the autoimmune disease type 1 diabetes in the future.

Type 1 diabetes is the most common metabolic disease in childhood and adolescence, with rapidly growing numbers. In Germany, about 1 in 250 children and adolescents is affected. Almost 90 percent of children with the disease do not have close relatives with type 1 diabetes. The disease can therefore affect any child. One of the biggest issues of the disease is that it is usually not recognized until severe, and in some cases, life-threatening symptoms have already developed. If more children are screened for diabetes risk early on, these instances can be prevented. However, unfortunately, screening measures are still not universally available and very few clinical studies offer early detection tests.

A few drops of blood is all it takes for early detection

For Anette-Gabriele Ziegler, the fight against type 1 diabetes is near and dear to her heart. Together with her colleagues, the Fr1da study, the world's largest population-based screening for type 1 diabetes in children, was launched at Helmholtz Munich. Since 2015, families in Bavaria have had the opportunity to have children between the ages of two and ten tested for early stages of this autoimmune disease thanks to Fr1da. To do this, scientists only need a few drops of the child's blood. If so-called islet autoantibodies are present in the blood, it is an indicator for inflamed insulin-producing cells of the pancreas. These antibodies can be detected in the blood years before symptoms occur and are important tools for the early diagnosis of type 1 diabetes.

Type 1 diabetes: A lifelong insulin deficiency

Type 1 diabetes is an autoimmune disease. The body's immune system, which primarily fights off pathogenic germs, attacks and destroys the insulin-producing cells of the pancreas. As a result, insulin production stops. The hormone insulin transports glucose, after being absorbed from food, from the blood into the cells to be used for energy production. In the case of insulin deficiency, glucose accumulates in the blood. People with type 1 diabetes, must therefore inject insulin to prevent far-reaching health issues caused by excessively high blood glucose levels.

Early detection enables better treatment

In the first four years of the Fr1da study, 90,632 children in Bavaria were examined; 280 children (0.31 percent) were diagnosed with early-stage type 1 diabetes. It can be assumed that of these children, half will clinically manifest type 1 diabetes within five years, and about another third within five to ten years. The remaining children with early-stage type 1 diabetes (20%) will require insulin treatment in ten to twenty years.

In order to prepare parents of affected children, they can participate in a training program as part of the Fr1da study. Parents are gradually familiarized with insulin therapy and are referred early-on to a pediatrician's office or pediatric clinic specializing in type 1 diabetes. In addition, researchers of the Fr1da study have developed a new method (progression likelihood score) that allows for the identification of children with rapid disease development—about 50 percent become insulin-dependent within two years. These children, therefore benefit from earlier and better treatment management, as well as have access to new therapies.

In various prevention studies, the researchers at Helmholtz Munich are investigating whether children's immune systems can be regulated by an array of therapies, such as taking insulin powder. Through these therapeutic interventions, the development of the autoimmune disease can be prevented or delayed in the future.

Anette-Gabriele Ziegler and her team have also been working on promising approaches to cure the disease. The drug teplizumab ensures for the reduction of destroyed beta cells by the body's own immune system—thereby delaying the autoimmune disease by several years. Commercial approval is currently being sought for in the United States. Early detection can identify children who will benefit the most from such treatment.

Early detection tests cost only 22 euros—detection for all children

9 out of 10 children with the type 1 diabetes do not have close relatives with the disease. Researchers like Anette-Gabriele Ziegler and her colleague Peter Achenbach are therefore calling for early detection of type 1 diabetes to be made available to all children in Germany in the future. They want early detection tests to be included in standard care practice by healthcare providers.

In the Fr1da study, the cost of screening was around 28 euros per child. Adopting these screening measures in standard medical care could reduce the cost to about 22 euros per screened child, as estimated by Helmholtz Munich researchers. These costs can be offset by the potential savings for the healthcare system through the prevention of metabolic disorders and their accompanied secondary diseases. Research has shown that children have an improved quality of life as a result of an early diagnosis and that parents of early diagnosed children were less stressed.

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Latest update: August 2022.

The Scientists

Portrait Peter Achenbach

Prof. Dr. med. Peter Achenbach

Deputy Director, Lead Scientist Research Area: Study Center for Childhood Diabetes

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