Early Diabetes Screening in Kids Can Improve Quality of Life
Research shows screening children ages 2-6 best predicts childhood type 1 diabetes, successfully detecting 80% of future cases. Early screening also leads to more timely treatment, better health outcomes, and less diabetes distress.
The Fr1da study, Autoimmunity Screening for Kids (ASK) program, and Type 1 Diabetes Prediction and Prevention (DIPP) study have all shown the importance of population-level screening and monitoring for type 1 diabetes.
Anette Gabriele Ziegler, director of the Institute of Diabetes Research at Helmholtz Munich, reviewed findings from the Fr1da study that screened 90,632 children aged 2-5 years for pre-symptomatic type 1 diabetes. Children previously diagnosed with early stage type 1 diabetes had a low prevalence of diabetic ketoacidosis (DKA) (2.5%).
In addition, children who were screened early on had lower A1C levels (6.8%) compared to kids without an early diagnosis (10.5%). The same study also showed that early screening led to improved quality of life and reduced distress.
Based in Colorado, the ASK program has screened over 32,000 children (ages 1-18 years) and found a 1% prevalence of pre-symptomatic type 1 diabetes. Christy Geno Rasmussen, professor at the Barbara Davis Center for Childhood Diabetes in Colorado, said she sees screening and monitoring along the same continuum of care, and anticipates that screening will become the standard of care in children and adolescents.
Like Fr1da, DKA at diagnosis was significantly lower among screened children (less than 5%) compared to unscreened children (62%). Rasmussen also highlighted an analysis showing that screening is cost-effective if it decreases the overall rate of DKA by one-fifth (i.e., from 50% to 40%) and subsequently decreases A1C by 1 percentage point.
Regarding who and when to screen, Ziegler and Rasmussen highlighted a longitudinal study that identified optimal ages to screen for diabetes in children under age 15. The study found that screening at ages 2-6 years successfully predicted 80% of future type 1 childhood diabetes cases.
Ritta Veijola, a professor at the University of Oulu in Finland, also agreed on the value of general population screening. After following up on the 1994 DIPP study, Veijiola and her colleagues confirmed that the number of islet autoantibodies (markers that estimate the risk of type 1 diabetes) was very predictive, highlighting the importance of early screening for preventive care.
Dr. Veijola said that optimal screening ages differ by country. For example, while islet autoantibody screening was most effective at ages 2-6 years in Finland (predicting 74% of diagnoses), the DAISY Denver cohort showed that screening was most effective at ages 2-9 years (predicting 66% of diagnoses).
In summary, early screening for diabetes in kids has benefits including:
Lower rates of DKA
Improved long-term health outcomes
Less stress and better quality of life
Prevention and preservation of insulin-producing cells in the pancreas
While the evidence is there, guidance and implementation of early screening in kids hasn’t yet followed. Rasmussmen emphasized the need to work towards the adoption of universal screening at the state government, payer, and healthcare provider levels.