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Cited by 129Diabetes and associated disordersDiabetes Management and ResearchPancreatic function and diabetes

Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation

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Hummel, Sandra, Carl, Johanna, Friedl, Nadine, Winkler, Christiane, Kick, Kerstin, Stock, Joanna, Reinmüller, Franziska, Ramminger, Claudia +16 more·2023·Diabetologia
DOI 10.1007/s00125-023-05953-0PMC PMC10390633
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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: At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA 1c (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. Graphical Abstract:

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  • Early detection offers clinical benefits, such as statistically significant reductions in diabetic ketoacidosis and a milder onset of clinical diabetes.

    “Although early detection offers clinical benefits, such as statistically significant reductions in diabetic ketoacidosis and a milder onset (ie, fewer symptoms and a lower degree of hyperglycaemia) of clinical diabetes, 13”

    From The future of type 1 diabetes therapy (2025) · cites this paper as [13]

    The Results (Clinical presentation at diagnosis of stage 3 type 1 diabetes; page unavailable) show significantly lower HbA1c and fasting glucose in previously screened children, supporting a milder onset with less hyperglycaemia. The Results report DKA in only 2.5% of those children and symptoms in 43.8%, but do not report a statistically significant reduction in DKA or a comparison establishing fewer symptoms. The significant reduction reported is for ketonuria, which is not the same as DKA. (LLM, conf=0.88)

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  • Public health screening using islet autoantibodies reduces diabetic ketoacidosis.

    “Although early detection offers clinical benefits, such as statistically significant reductions in diabetic ketoacidosis and a milder onset (ie, fewer symptoms and a lower degree of hyperglycaemia) of clinical diabetes, 13”

    From The future of type 1 diabetes therapy (2025) · cites this paper as [13]

    The Results (Table 1) report DKA in 3 of 118 previously screened children (2.5%), and the Discussion describes a low DKA prevalence and milder clinical presentation. The paper reports statistically significant differences in measures such as fasting glucose and ketonuria (Results, Table 2), but does not establish a statistically significant reduction in DKA itself compared with unscreened children. (LLM, conf=0.88)

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References 43 · Cited by 129

Research works printed but not linked: 39

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Authors
Hummel, S., Carl, J., Friedl, N., Winkler, C., Kick, K., Stock, J., Reinmüller, F., Ramminger, C., Schmidt, J., Lwowsky, D., Braig, S., Dunstheimer, D., Ermer, U., Gerstl, E.-M., Weber, L., Nellen-Hellmuth, N., Brämswig, S., Sindichakis, M., Tretter, S., Lorrmann, A., Bonifacio, E., Ziegler, A.-G., Achenbach, P., & for the Fr1da Study Group
Affiliations
  • TUM Klinikum (DE)
  • Helmholtz Munich (DE)
  • Nuremberg Hospital (DE)
  • Bayreuth Medical Center (DE)
  • Klinikum Passau (DE)
  • RoMed Kliniken (DE)
  • Klinikum Weiden (DE)
  • St. Josefskrankenhaus Freiburg (DE)
  • German Center for Diabetes Research (DE)
Corresponding author
  • Hummel, Sandra
  • Achenbach, Peter
ORCID
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2023-06-17
Volume
66
Issue
9
Pages
1633-1642
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-023-05953-0
PMC
PMC10390633
OpenAlex
W4381053264
Cited by
129
References
43
Citations by year
2026: 54 · 2025: 34 · 2024: 34 · 2023: 7
FWCI
21.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetologia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion, cc-by)
  • OPUS (Augsburg University) (submittedVersion, cc-by)
  • mediaTUM (Technical University of Munich) (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
Funders
  • Bundesministerium für Bildung und Forschung (FKZ01GI0805, FKZ01KX1818)
  • Juvenile Diabetes Research Foundation International (1-SRA-2014-310-M-R, 3-SRA-2015-72-M-R, 3-SRA-2019-718-Q-R)
  • German Center for Diabetes Research (DZD) e.V.
  • Leona M. and Harry B. Helmsley Charitable Trust (G-1911-3274)
  • LifeScience Stiftung (HMGU 2014.01, HMGU 2016.01)
  • Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
type 1 diabetes, children, HbA1c, fasting C-peptide, ketonuria, diabetic ketoacidosis, insulin therapy, patient education, disease surveillance
MeSH terms
COVID-19, Child, Diabetes Mellitus, Type 1, Humans, Insulin, Public Health, Pandemics

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