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. 2023 Sep;66(9):1633-1642.
doi: 10.1007/s00125-023-05953-0. Epub 2023 Jun 17.

Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation

Sandra Hummel  1   2   3   4 , Johanna Carl  5 , Nadine Friedl  5 , Christiane Winkler  5   6   7 , Kerstin Kick  8 , Joanna Stock  5 , Franziska Reinmüller  8 , Claudia Ramminger  5 , Jennifer Schmidt  7 , Dominik Lwowsky  9 , Sonja Braig  10 , Desiree Dunstheimer  11 , Uwe Ermer  12 , Eva-Maria Gerstl  13 , Leonie Weber  14 , Nicole Nellen-Hellmuth  15 , Susanne Brämswig  16 , Marina Sindichakis  17 , Stefanie Tretter  18 , Anja Lorrmann  19 , Ezio Bonifacio  6   20   21 , Anette-G Ziegler  5   6   7   8 , Peter Achenbach  22   23   24   25 ; Fr1da Study Group
Affiliations

Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation

Sandra Hummel et al. Diabetologia. 2023 Sep.

Abstract

Aims/hypothesis: We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies.

Methods: Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening.

Results: At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis.

Conclusions/interpretation: Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes.

Keywords: Children; Early-stage diagnosis; Islet autoantibodies; Screening; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
HbA1c (a), fasting glucose (b), fasting C-peptide (c) and BMI-SDS (d) at diagnosis of stage 3 type 1 diabetes are shown for children previously diagnosed with presymptomatic type 1 diabetes in the Fr1da study compared with children diagnosed with incident type 1 diabetes in the DiMelli study who had not participated in prior screening. *p<0.05, **p<0.01, ***p<0.001
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