In the Journals

Islet autoantibody screening may reveal pediatric type 1 diabetes risk

Anette-Gabriele Ziegler

Presymptomatic type 1 diabetes increases the risk for developing clinical type 1 diabetes in children aged 2 to 5 years, but can be identified via islet autoantibody screening, according to findings published in JAMA.

“We want to reduce diabetic ketoacidosis, but we and many others believe that the true goal is to prevent clinical type 1 diabetes. Until now, where screening has been limited to people with a family history of type 1 diabetes, it takes several years to recruit for prevention trials,” Anette-Gabriele Ziegler, MD, of the Institute of Diabetes Research at Helmholtz Zentrum München in Neuherberg, Germany, and told Healio. “Here we have shown that population screening works, and this means that we can identify much larger numbers of people who could benefit from prevention and markedly reduce the time to recruit into trials and, therefore, shorten the time to reach our goal of prevention.”

Ziegler and colleagues conducted islet autoantibody screening using the blood samples from 90,632 children aged 1.75 to 5.99 years residing in Bavaria, Germany (median age, 3.1 years; 48.5% girls). Participants with at least two islet autoantibodies were diagnosed with presymptomatic type 1 diabetes. The researchers established three stages of presymptomatic type 1 diabetes, culminating in clinical type 1 diabetes (stage 3).

The researchers then evaluated the incidence of clinical type 1 diabetes and diabetic ketoacidosis during 2.4 years of median follow-up among the children who were considered presymptomatic as well as those who were not. In addition, participants’ parents completed the Patient Health Questionnaire-9 at baseline, 6 months and 12 months to evaluate psychological stress.

Diabetes child 2019 
Presymptomatic type 1 diabetes increases the risk for developing clinical type 1 diabetes in children aged 2 to 5 years, but can be identified via islet autoantibody screening.
Source: Adobe Stock

The researchers identified presymptomatic type 1 diabetes in 280 participants. Stage 1 occurred in 196 participants, stage 2 in 17 participants and stage 3 in 26 participants.

During follow-up, those with presymptomatic type 1 diabetes had a 24.9% cumulative risk (95% CI, 18.5-30.7) and 9% annualized risk for reaching stage 3 type 1 diabetes. There was a 28.7% cumulative risk (95% CI, 21-35.6) and a 10.6% annualized risk for stage 2 and/or stage 3 type 1 diabetes for those with stage 1 presymptomatic type 1 diabetes at baseline.

There were two cases of diabetic ketoacidosis in the cohort with presymptomatic type 1 diabetes, according to the researchers, who noted that four children who did not have presymptomatic type 1 diabetes at baseline went on to have clinical type 1 diabetes. In addition, mothers of children who met presymptomatic type 1 diabetes criteria had a median score of 3 on the Patient Health Questionnaire-9 whereas mothers of those who did not meet the criteria had a median score of 2 (P = .002), indicating a higher degree of psychological stress for the first group. However, the researchers noted that “the scores declined significantly over time.”

“This sort of screening would reduce the number of acute and dangerous cases of type 1 diabetes that we would see,” Ziegler said. “Care would start at a much earlier stage when the child is still feeling well. It gives time to learn about the disease, adjust to the likelihood of clinical disease whenever it occurs.” – by Phil Neuffer

For more information:

Anette-Gabriele Ziegler, MD, can be reached at anette-g.ziegler@helmholtz-muenchen.de.

Disclosures: Ziegler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Anette-Gabriele Ziegler

Presymptomatic type 1 diabetes increases the risk for developing clinical type 1 diabetes in children aged 2 to 5 years, but can be identified via islet autoantibody screening, according to findings published in JAMA.

“We want to reduce diabetic ketoacidosis, but we and many others believe that the true goal is to prevent clinical type 1 diabetes. Until now, where screening has been limited to people with a family history of type 1 diabetes, it takes several years to recruit for prevention trials,” Anette-Gabriele Ziegler, MD, of the Institute of Diabetes Research at Helmholtz Zentrum München in Neuherberg, Germany, and told Healio. “Here we have shown that population screening works, and this means that we can identify much larger numbers of people who could benefit from prevention and markedly reduce the time to recruit into trials and, therefore, shorten the time to reach our goal of prevention.”

Ziegler and colleagues conducted islet autoantibody screening using the blood samples from 90,632 children aged 1.75 to 5.99 years residing in Bavaria, Germany (median age, 3.1 years; 48.5% girls). Participants with at least two islet autoantibodies were diagnosed with presymptomatic type 1 diabetes. The researchers established three stages of presymptomatic type 1 diabetes, culminating in clinical type 1 diabetes (stage 3).

The researchers then evaluated the incidence of clinical type 1 diabetes and diabetic ketoacidosis during 2.4 years of median follow-up among the children who were considered presymptomatic as well as those who were not. In addition, participants’ parents completed the Patient Health Questionnaire-9 at baseline, 6 months and 12 months to evaluate psychological stress.

Diabetes child 2019 
Presymptomatic type 1 diabetes increases the risk for developing clinical type 1 diabetes in children aged 2 to 5 years, but can be identified via islet autoantibody screening.
Source: Adobe Stock

The researchers identified presymptomatic type 1 diabetes in 280 participants. Stage 1 occurred in 196 participants, stage 2 in 17 participants and stage 3 in 26 participants.

During follow-up, those with presymptomatic type 1 diabetes had a 24.9% cumulative risk (95% CI, 18.5-30.7) and 9% annualized risk for reaching stage 3 type 1 diabetes. There was a 28.7% cumulative risk (95% CI, 21-35.6) and a 10.6% annualized risk for stage 2 and/or stage 3 type 1 diabetes for those with stage 1 presymptomatic type 1 diabetes at baseline.

There were two cases of diabetic ketoacidosis in the cohort with presymptomatic type 1 diabetes, according to the researchers, who noted that four children who did not have presymptomatic type 1 diabetes at baseline went on to have clinical type 1 diabetes. In addition, mothers of children who met presymptomatic type 1 diabetes criteria had a median score of 3 on the Patient Health Questionnaire-9 whereas mothers of those who did not meet the criteria had a median score of 2 (P = .002), indicating a higher degree of psychological stress for the first group. However, the researchers noted that “the scores declined significantly over time.”

“This sort of screening would reduce the number of acute and dangerous cases of type 1 diabetes that we would see,” Ziegler said. “Care would start at a much earlier stage when the child is still feeling well. It gives time to learn about the disease, adjust to the likelihood of clinical disease whenever it occurs.” – by Phil Neuffer

For more information:

Anette-Gabriele Ziegler, MD, can be reached at anette-g.ziegler@helmholtz-muenchen.de.

Disclosures: Ziegler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.