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. 2024 Apr 18:12:1386513.
doi: 10.3389/fped.2024.1386513. eCollection 2024.

Home capillary sampling and screening for type 1 diabetes, celiac disease, and autoimmune thyroid disease in a Swedish general pediatric population: the TRIAD study

Maria Naredi Scherman  1   2 , Alexander Lind  1 , Samia Hamdan  1 , Markus Lundgren  1   3 , Johan Svensson  1   2 , Flemming Pociot  4   5 , Daniel Agardh  1   2
Affiliations

Home capillary sampling and screening for type 1 diabetes, celiac disease, and autoimmune thyroid disease in a Swedish general pediatric population: the TRIAD study

Maria Naredi Scherman et al. Front Pediatr. .

Abstract

Objective: To screen a general pediatric population for type 1 diabetes (T1D), celiac disease (CD), and autoimmune thyroid disease (AITD) after home capillary sampling.

Methods: Swedish schoolchildren between 6-9 years and 13-16 years of age were invited to screening by taking a capillary sample at home. Samples were returned by mail and assessed for autoantibodies associated with T1D, CD, and AITD. Persistently autoantibody-positive children were referred for clinical follow-up.

Results: Of 19,593 invited, 3,527 (18.0%) consented to participate and 2,315/3,527 (65.6%) returned a blood sample of sufficient volume. Hemolysis occurred in 830/2,301 (36.1%) samples. After exclusion of 42 children with previously known T1D, CD, or AITD, and two autoantibody-positive children who declined a confirmatory sample, 2,271/19,593 (11.6%) were included. 211/2,271 (9.3%) had persistent autoantibodies: 60/2,271 (2.6%) with T1D autoantibodies, 61/2,271 (2.7%) with CD autoantibodies, and 99/2,271 (4.4%) with AITD autoantibodies; 9/2,271 (0.4%) were autoantibody positive for ≥1 disease. After clinical follow-up, 3/2,271 (0.1%) were diagnosed with T1D, 26/2,271 (1.1%) with CD, and 6/2,271 (0.3%) with AITD. Children with a first-degree relative (FDR) with T1D, CD, and/or AITD, had higher occurrence of autoantibodies compared to children without an FDR (63/344, 18.3%, vs. 148/1,810, 8.2%) (p < 0.0001, OR 2.52, 95% CI 1.83-3.47), and higher occurrence of screening-detected diagnosis (14/344, 4.1%, vs. 21/1,810, 1.2%) (p < 0.0001, OR 3.61, 95% CI 1.82-7.18). Half of these children screened positive for another disease than the FDR.

Conclusion: Screening for T1D, CD, and AITD by home capillary sampling in a Swedish general pediatric population detected autoimmunity in 9.3% and undiagnosed disease in 1.5%.

Keywords: autoimmune diseases; autoimmune thyroid disease; celiac disease; pediatrics; screening; type 1 diabetes.

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Conflict of interest statement

DA has received grants from the Novo Nordisk Foundation, presenter fee from Sanofi at ISPAD 2023 in Rotterdam (NL), and has been scientific consultant at Allero Therapeutics. ML has received speaker fee from Rubin Medical related to team development. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the TRIAD-study. Aab+, autoantibody positive; Aab-, autoantibody negative; T1D, type 1 diabetes; CD, celiac disease; AITD, autoimmune thyroid disease.
Figure 2
Figure 2
Overlap of autoantibody-positive children (Aab+) and children with screening-detected disease. Number of screened children, n = 2,271. Number of Aab+ children, n = 211. Number of children with screening-detected diagnosis, n = 35. T1D, type 1 diabetes; CD, celiac disease; AITD, autoimmune thyroid disease.
Figure 3
Figure 3
Diagnosis in first-degree relatives (FDRs) of autoantibody-positive (Aab+) children and children with screening-detected diagnosis T1D, type 1 diabetes; CD, celiac disease; AITD, autoimmune thyroid disease.
See this image and copyright information in PMC

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