General population screening for childhood type 1 diabetes: is it time for a UK strategy?

Abstract

Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awareness campaigns, DKA rates have not fallen over the last decade. T1D has a long prodrome, and it is now possible to identify children who go on to develop T1D with a high degree of certainty. The reasons for identifying children presymptomatically include prevention of DKA and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression. Research studies of population-based screening strategies include using islet autoantibodies alone or in combination with genetic risk factors, both of which can be measured from a capillary sample. If found during screening, the presence of two or more islet autoantibodies has a high positive predictive value for future T1D in childhood (under 18 years), offering an opportunity for DKA prevention. However, a single time-point test will not identify all children who go on to develop T1D, and so combining with genetic risk factors for T1D may be an alternative approach. Here we discuss the pros and cons of T1D screening in the UK, the different strategies available, the knowledge gaps and why a T1D screening strategy is needed.

Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies

“…Moreover, screening for type 1 diabetes through islet autoantibodies and genetic testing is currently reserved for research ( 62 ). However, one main advantage of such screening at the population level would be the reduction of DKA at type 1 diabetes onset ( 63 ). This was observed in two studies were significant reductions in DKA frequency was noted ( 64 , 65 ).…”

What does the licensing of teplizumab mean for diabetes care?

“…The optimal method for monitoring during follow‐up also needs clarification: both before and after teplizumab therapy; including the utility of tools to assess metabolic status (e.g. HbA1c or OGTT), risk scores, and the frequency and location of follow‐up 38,46 . Currently, monitoring is offered through research programmes such as INNODIA, with 6‐monthly OGTT testing for those with multiple autoantibodies and 2‐yearly autoantibody screening for those with a single positive autoantibody.…”

Beta cell and immune cell interactions in autoimmune type 1 diabetes: How they meet and talk to each other

“…Perhaps islet autoantibodies will provide us with a tool to determine pancreatic endotype and focus treatment accordingly, but again this requires further investigation. It is important to note that for this strategy to be successful, a population screening program would have to be initiated and strides are being made towards this [ 12 , 90 , 216 ].…”