Scientific highlights

14.02.2022

Type 1 diabetes in children: Only 22 euros for an early diagnosis before symptoms arise

It only takes a blood test to detect the autoimmune disease type 1 diabetes in children at an early stage and, thus, prevent severe metabolic derailments. Helmholtz Munich offers the world's largest population-based screening for type 1 diabetes in children, the Fr1da study. Researchers have now published a detailed cost analysis about the testing strategy. Introducing screenings into standard care would presumably cost the health care system in Germany 22 euros per child screened.

Worldwide, four in thousand people under the age of 20 have type 1 diabetes. It is the most common metabolic disease in children and adolescents. Only about one in ten of those affected has a close relative with the disease. This means that type 1 diabetes can affect any child. If detected early, doctors can monitor and treat the diseases effectively. However, in many cases, the disease does not become known until a severe to life-threatening metabolic derailment occurs. This often leads to intensive medical treatment, a longer hospitalization, a poorer blood sugar control resulting in an increased risk of secondary diseases, and very high costs for the healthcare system. 

Screening as standard care
“We want to protect as many children as possible from serious metabolic derailments. This is only possible with type 1 diabetes screenings. Therefore, we strongly support to include early-detection tests in standard medical care”, says Peter Achenbach, one of the study leaders at Helmholtz Munich.

To date, only very few studies have performed a population-wide screening for early stages of type 1 diabetes. The Fr1da study led by Helmholtz Munich closes this gap: Since 2015, children aged 2-5 years in Bavaria, Germany, could have their blood tested for so-called islet autoantibodies. The antibodies are signs of an inflammation and destruction of the insulin-producing beta cells of the pancreas. This way, researchers can detect an early stage of type 1 diabetes years before insulin deficiency and elevated blood sugar levels occur with symptoms of the disease. In collaboration with 682 pediatricians and 16 pediatric diabetes clinics in Bavaria, 90,632 children were tested within the first four years of the Fr1da study; 280 children (0.31 percent) were diagnosed with an early stage of type 1 diabetes.

Potential costs for the healthcare system
In the current analysis, the researchers estimate the costs of the screening. Within the Fr1da study, the costs per child was around 28 euros. If screenings were to be included in standard medical care, the researchers assume that the amount could reduce to about 22 euros per child screened. 

The cost analysis covers the procurement, processing and analysis of the blood samples, as well as the communication of the results. It also includes expenses for tests to assess the beta cell function and blood sugar level, as well as for prevention training and counseling for affected children and their families.

“Although our analyses are subject to some level of uncertainty, they provide a benchmark for the expected implementation cost  of screening,” explains Michael Laxy, also a study leader at Helmholtz Munich. “Next, we aim to evaluate the long-term ratio of screening costs, potential cost savings through the prevention of metabolic derailment and its consequences, and potentially increased quality of life with a type 1 diabetes screening compared to the costs and quality of life without a screening.”

About the people

Prof. Peter Achenbach is a diabetes researcher at the Helmholtz Diabetes Center at Helmholtz Munich. He works as deputy director at the Institute of Diabetes Research under the direction of Prof. Anette-Gabriele Ziegler. Achenbach is also a scientist at the German Center for Diabetes Research (DZD), which is co-funding the Fr1da study along with other partners. In addition, he works at the Klinikum rechts der Isar of the Technical University of Munich (TUM). Prof. Michael Laxy is a health economist, epidemiologist and public health researcher. He is Professor of Public Health and Prevention at TUM and leads the working group on Economics and Management of Diabetes at the Institute for Health Economics and Management in Health Care at Helmholtz Munich.

Original publication

Karl et al., 2022: Costs of Public Health Screening of Children for Presymptomatic Type 1 Diabetes in Bavaria, Germany. Diabetes Care, DOI: 10.2337/dc21-1648.