Presentation and characteristics of children with screen-detected type 1 diabetes: learnings from the ELSA general population pediatric screening study

Abstract

Introduction: We describe the identification and management of general population screen-detected type 1 diabetes (T1D) and share learnings for best practice.

Research design and methods: Children diagnosed with T1D through a general population screening initiative, the EarLy Surveillance for Autoimmune diabetes (ELSA) study, were reviewed and described.Parents provided written, informed consent for inclusion in the case series.

Results: 14 children with insulin requiring (stage 3) T1D are described. These cases offer unique insights into the features of screen-detected T1D. T1D is identified sooner through screening programs, characterized by absent/short symptom duration, median presenting glycated hemoglobin 6.6% (49 mmol/mol) and insulin requirements<0.5 units/kg/day. ELSA identified four children at stage 3 and another 4 progressed within 4 months of ELSA completion, including two single seropositive children. Six children developed stage 3 T1D prior to ELSA completion, including two children (14%, n=2/14) with diabetic ketoacidosis prior to confirmed antibody status.

Conclusions: There are three main learnings from this case series. First, T1D identified through screening is at an earlier stage of its natural history and requires personalized insulin regimens with lower total daily insulin doses. Second, single autoantibody seropositivity can rapidly progress to stage 3. Finally, insulin requirement can manifest at any stage of the T1D screening pathway, and therefore early education around symptom recognition is essential for families participating in screening programs.

Keywords: Antibodies; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Screening.

Figure 1. Summary of stage 3 cases identified in the ELSA study. Figure outlining where stage 3 cases were identified during the ELSA study. Four children were diagnosed after study enrollment and prior to DBS results notification (cases 10–13). One child was diagnosed following DBS results notification but prior to venous autoantibody (Aab) confirmation (case 14). Of these, two children had mild DKA. Two children progressed to stage 3 within 2 months of single Aab results notification (cases 7–8) and one child progressed to stage 3 prior to metabolic staging (case 9). Four children had stage 3 T1D from the ELSA OGTT (cases 1–4). Two children progressed from presymptomatic to symptomatic T1D within 6 months of ELSA staging (cases 5–6). DBS, dried blood spot; DKA, diabetic ketoacidosis; ELSA, EarLy Surveillance for Autoimmune diabetes; mAab, multiple autoantibody positive; OGTT, oral glucose tolerance testing; sAab, single autoantibody positive; T1D, type 1 diabetes.