Screening children for presymptomatic type 1 diabetes

INTRODUCTION

Type 1 diabetes (T1D) is one of the commonest chronic conditions of childhood.¹ The pathophysiology of T1D comprises four stages of which the first two are presymptomatic and hallmarked by autoantibodies, and the last two are accompanied by hyperglycaemia. Screening for autoantibodies enables confident and early identification of children at risk of progression into hyperglycaemia.² Benefits of screening include a reduced risk of being diagnosed as a diabetic emergency (diabetic ketoacidosis, DKA), opportunity to prepare the family for a future with T1D, and intervention trials testing new treatments to delay onset of disease.³ The first study to assess feasibility and acceptability of screening in the UK is the EarLy Surveillance for Autoimmune diabetes (ELSA) study, which is currently open to recruitment. This analysis article will provide the rationale for screening, give an overview of the international screening landscape, discuss the benefits and risks of screening children for T1D, and examine the impact of screening on general practice.

Over 30 000 children in the UK are affected by T1D, with an incidence of 30.9 cases per 100 000,⁴ which is rising globally.⁵ GPs may only diagnose T1D a few times in their career, yet it remains a significant concern for fear of delayed or missed diagnosis resulting in a child progressing to DKA.⁶ Rates of severe DKA increased during the SARS-CoV-2 pandemic, likely due to late presentations.⁷ Diagnosis of T1D in children in primary care is challenging and retrospective studies demonstrate missed opportunities for diagnosis. In the 12 months leading up to T1D diagnosis, children were 6.5 times more likely to see the GP.⁸ Furthermore, the remote consultations delivered by GPs during the height of the pandemic made making a diagnosis of T1D more challenging because of lack of point-of-care testing.⁹

Approximately …