Early Detection of Type 1 Diabetes: New Position Paper Published

Number of Children with Type 1 Diabetes Increases 

More and more children and adolescents in Germany develop type 1 diabetes, the most common autoimmune-induced metabolic disorder in children. Typically, type 1 diabetes is diagnosed at a late timepoint in disease progression. Islet autoantibodies in the blood can serve as biomarkers to detect the autoimmune process early on and long before first symptoms appear. Currently, such screening is offered as part of the Helmholtz Munich-led Fr1da study in Bavaria, Saxony, Lower Saxony, and Hamburg.

Population Based Screening Has Benefits for Individuals

In the position paper, the researchers summarize decades of findings on the early detection of type 1 diabetes:

• Diagnosis at early stage of the disease reduces the occurrence of metabolic derailments and ketoacidosis during the clinical manifestation of type 1 diabetes. This can prevent neurocognitive impairments.
• Early diagnosis is associated with a milder disease progression and improved long-term insulin secretion. This can lead to improved long-term metabolic control and potentially reducing or shortening hospital stays.
• Early detection of type 1 diabetes provides affected families with time to prepare for the disease management, thereby reducing psychological stress at clinical manifestation.
• Additionally, the authors emphasize the relevance of early detection for the application of disease-delaying therapies, such as Teplizumab treatment, which may become available in Germany in the upcoming years. This monoclonal CD3-antibody is currently approved in the USA and can delay the progression of the autoimmune disease by two to three years—provided that type 1 diabetes is detected at an early-stage.

Successful Early Detection Requires Qualified Counseling and Care

The authors also mention potential risks associated with participating in an early detection program. Currently, the exact time point of disease manifestation in a positively screened child cannot be predicted. Knowledge of an early stage, along with regular self-monitoring and doctor visits, could adversely affect the thinking and behavior of parents. Conversely, a negative screening result might lead to a false sense of security, increasing the risk of diabetic ketoacidosis in some children. In light of these considerations, the authors of the position paper stress the importance of qualified counseling and care for participating families.

Researchers Call for Rapid Integration of Early Detection into the German Health Care System

The authors postulate to inform about and offer the early detection of type 1 diabetes within the standard care for children. Key steps for implementing screening in Germany include the training of pediatricians and the expansion of regional capacities for the care of affected children. The position paper highlights the urgency of comprehensive screening to reduce severe metabolic derailments overall and improve the prospects for affected children and their parents.