Time to think about a population screening program for type 1 diabetes in children: an ESPE Position Statement
09 Sep 2022
Type 1 Diabetes (T1D) is the most frequent chronic autoimmune disease in children and adolescents; its incidence is increasing particularly in toddlers and preschool children and up to 60% of young patients present with diabetic ketoacidosis (DKA) a severe and life-threatening complication.
So far the majority of screening efforts have been performed in at risk groups, however 90% of young patients who eventually develop T1D do not have a family history.
Some European and US studies have shown the effectiveness of public health screening in children in reducing the prevalence of DKA by more than tenfold, thus decreasing the rate of hospitalisation and its costs.
There is so far no cure for T1D and so patients are destined for a lifelong insulin treatment and in most cases the development of disease-related complications, which have a huge impact on patients, their families and the health systems.
It has been suggested that early screening for T1D in children can become cost effective due to cheaper antibody screening methods, prevention of DKA hospitalisations and thus reduced possible future costs associated with this and other T1D complications.
In addition, early diagnosis for stage 2 T1D could offer children and their families an opportunity to participate in clinical trials with the aim to delay the clinical manifestations of the disease. There are several ongoing trials in Europe and USA, and some drugs have proved promising in significantly delaying of progression to the disease.
The identification of T1D through mass general pediatric population screening prior to any clinical signs provides opportunities to teach these people and family members to monitor and recognize early signs of diabetes and preventing DKA.
However, although the safe treatment that delays or prevents disease is eagerly awaited, the economic burden of such a benefit is unknown. Attitudes towards screening are divergent among European countries. The fundamental expectations from health authorities are that there must be clear economic and health benefits as well as effective medical care that can partly prevent or delay the onset of symptomatic disease and reduce complications.
The ESPE Position Statement was just published on Hormone Research in Paediatrics (doi: 10.1159/000525824), points out the benefits of a screening programs for T1D in the general population (reduce DKA incidence at onset, preserve beta-cell function and possibly offer secondary prevention to these children) and paves the way for further discussion on the pros and cons of this approach.
Francesco Chiarelli, Department of Paediatrics, University of Chieti, Italy