Effect of screening for type 1 diabetes on early metabolic control: the DiPiS study

Abstract

Aims/hypothesis It has been shown that children previously enrolled in follow-up studies have better glycaemic control during the early period after diabetes diagnosis. The aim of this study was to analyse glycaemic control over a longer period, past the period of partial remission, after diagnosis in children followed before diagnosis in the Swedish Diabetes Prediction in Skåne (DiPiS) study compared with children of equal age not enrolled in pre-diabetes follow-up, receiving equivalent diabetes care. Methods HbA 1c from diagnosis and for the following 5 years, as well as differences in insulin dosage, BMI, pump use, partial remission according to insulin dose-adjusted HbA 1c and baseline demographics were compared between children who were enrolled in follow-up and had received information on diabetes risk (n = 51) and children not enrolled in follow-up (n = 78). Results The group followed before diagnosis had a higher proportion of first-degree relatives (FDRs) with diabetes (28% vs 5.6%; p = 0.001) and a higher proportion of participants with mothers born in Sweden (100% vs 89%; p = 0.02). No significant differences in total daily insulin dose, pump use or other baseline sociodemographic factors were detected between the groups. Median HbA 1c at diagnosis and at 1, 2, 3, 4 and 5 years after diabetes diagnosis was significantly lower in children followed before diagnosis (all p < 0.05), and was not related to FDR status. Conclusions/interpretation Compared with controls not previously enrolled in follow-up, our study shows that children enrolled in longitudinal follow-up before the diagnosis of diabetes have better glycaemic control, measured by HbA 1c , up to 5 years after diagnosis and during the initial period of partial remission. Improved glycaemic control in the initial years of living with type 1 diabetes could affect long-term outcome and complications and might also improve study enrolment in future longitudinal studies.

Decreased occurrence of ketoacidosis and preservation of beta cell function in relatives screened and monitored for type 1 diabetes in A ustralia and N ew Z ealand

“…Because beta cell function declines rapidly during progression from stage 2 to stage 3 T1D, 31 pre‐clinical diagnosis by islet autoantibody screening is expected to identify incipient stage 3 individuals who have relatively high beta cell reserve. This “lead time” effect has been directly confirmed by the demonstration that C‐peptide concentrations are higher in children who developed stage 3 disease in the TEDDY birth cohort study compared to age‐matched children diagnosed in the community 6 and is supported by several other studies of young children which show that screening is associated with lower HbA1c and insulin requirements at diagnosis 8–10 . We extend this finding to an older population by demonstrating in our cohort that HbA1c, insulin requirement and the IDAA1c measure of beta cell function are superior at diagnosis in screened populations.…”

“…This "lead time" effect has been directly confirmed by the demonstration that C-peptide concentrations are higher in children who developed stage 3 disease in the TEDDY birth cohort study compared to age-matched children diagnosed in the community 6 and is supported by several other studies of young children which show that screening is associated with lower HbA1c and insulin requirements at diagnosis. [8][9][10] We extend this finding to an older population by demonstrating in our cohort that HbA1c, Our data identified many individuals who were not followed-up with metabolic testing after their initial screen, even if it returned multiple islet autoantibodies. Such individuals were more likely to develop DKA than their counterparts who underwent monitoring.…”

“…Autoantibodies against insulin (IAA), glutamic acid decarboxylase (GADA), and insulinoma‐associated protein‐2 (IA‐2A) reliably identify children and young adults destined to develop insulin‐requiring (stage 3) T1D 4,5 . In birth cohort studies of genetically at‐risk European and North American children, early diagnosis through autoantibody screening and metabolic monitoring every 6–12 months is associated with a significantly lower frequency of diabetic ketoacidosis (DKA) at diagnosis of stage 3 disease (~5% compared to 30%–50% in the general population) and, over the first year, with better glucose control and a lower insulin requirement 6–9 . Studies of young children (age 2–6 years) in Germany have also shown that islet autoantibody screening affords protection from DKA irrespective of familial risk 10,11 …”

“…4,5 In birth cohort studies of genetically at-risk European and North American children, early diagnosis through autoantibody screening and metabolic monitoring every 6-12 months is associated with a significantly lower frequency of diabetic ketoacidosis (DKA) at diagnosis of stage 3 disease ($5% compared to 30%-50% in the general population) and, over the first year, with better glucose control and a lower insulin requirement. [6][7][8][9] Studies of young children (age 2-6 years) in Germany have also shown that islet autoantibody screening affords protection from DKA irrespective of familial risk. 10,11 In older populations, the effect of screening on DKA, glycaemia and insulin requirement is less certain.…”

Competing endogenous RNA network analysis explores the key lncRNAs, miRNAs, and mRNAs in type 1 diabetes

“…According to the WHO classification of diabetes mellitus in 2019, diabetes are classified as type 1 diabetes (T1D), type 2 diabetes (T2D), hybrid forms of diabetes, other specific types, such as monogenic diabetes, unclassified diabetes and hyperglyacemia first detected during pregnancy [ 6 , 7 ]. The symptoms of T1D mainly include thirst, polydipsia, polyuria, polyphagia, fatigue, and rapid weight loss [ 8 ].An annual 3%—4% increase in the incidence of T1D in childhood was estimated in several developed countries [ 9 ]. Besides, T1D decreases approximately 11–13 years of life expectancy in developed countries, and even more time in developing countries [ 10 ].…”