Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation
Sandra Hummel, Johanna Carl, Nadine Friedl, Christiane Winkler, Kerstin Kick, Joanna Stock, Franziska Reinmüller, Claudia Ramminger, Jennifer Schmidt, Dominik Lwowsky, Sonja Braig, Désirée Dunstheimer, Uwe Ermer, Eva-Maria Gerstl, L. A. Weber, Nicole Nellen‐Hellmuth, Susanne Brämswig, Marina Sindichakis, Stefanie Tretter, Anja Lorrmann, Ezio Bonifacio, Anette‐G. Ziegler, Peter Achenbach, for the Fr1da Study Group
Abstract
AIMS/HYPOTHESIS: We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. METHODS: Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. RESULTS: (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. CONCLUSIONS/INTERPRETATION: Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes.