Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up
Open accessAbstract
OBJECTIVE—The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis. RESEARCH DESIGN AND METHODS—The Diabetes Autoimmunity Study in the Young (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age- and sex-matched children concurrently diagnosed with diabetes in the community. RESULTS—Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P < 0.0001). They had a lower mean HbA1c at onset (7.2 vs. 10.9%; P < 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P < 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U · kg−1 · day−1; P = 0.003), 6 (0.37 vs. 0.58; P = 0.001), and 12 months (0.57 vs. 0.72; P = 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern. CONCLUSIONS—Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis.
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There is some evidence that early diagnosis may prevent hospitalization with ketoacidosis and preserve residual b-cells.
“There is some evidence that early diagnosis may prevent hospitalization with ketoacidosis and preserve residual b-cells (393).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [393]
The Onset hospitalization section (page not provided) reports far fewer hospitalizations among closely followed DAISY children than community cases, and the discussion describes decreased hospitalization for DKA at onset. The Insulin dose section reports lower insulin requirements after diagnosis, but the paper does not establish that early diagnosis preserves residual beta cells. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSuch testing, coupled with education about diabetes symptoms and close follow-up, has been shown to enable earlier diagnosis and to prevent DKA.
“Such testing, coupled with education about diabetes symptoms and close follow-up, has been shown to enable earlier diagnosis and to prevent DKA (77,78).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [77]
The paper describes symptom education and close monitoring for autoantibody-positive children. In ‘Onset hospitalization’ (page unavailable), it reports much lower hospitalization at diagnosis in followed children than in community cases (3.3% versus 44%); the discussion attributes their milder presentation to earlier detection and describes decreased hospitalization for DKA as an observed benefit. These findings support earlier diagnosis and reduced DKA-related hospitalization in this high-risk group, but do not establish that the approach prevents DKA altogether. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTesting coupled with education about diabetes symptoms and close follow-up has been shown to enable earlier diagnosis and to prevent DKA.
“Such testing, coupled with education about diabetes symptoms and close follow-up, has been shown to enable earlier diagnosis and to prevent DKA (77,78).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [77]
Some evidence suggests early diagnosis may prevent ketoacidosis hospitalization and preserve residual beta-cells.
“There is some evidence that early diagnosis may prevent hospitalization for ketoacidosis and preserve residual b-cells (271).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [271]
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Self-citation
- Authors
- Barker, J. M., Goehrig, S. H., Barriga, K., Hoffman, M., Slover, R., Eisenbarth, G. S., Norris, J. M., Klingensmith, G. J., & Rewers, M.
- Affiliations
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, Colorado
- Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-06-01
- Volume
- 27
- Issue
- 6
- Pages
- 1399-1404
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2126288005
- Cited by
- 220
- References
- 33
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 17 · 2023: 12 · 2022: 11 · 2021: 15 · 2020: 8 · 2019: 7 · 2018: 9 · 2017: 9 · 2016: 8 · 2015: 11 · 2014: 6 · 2013: 7 · 2012: 7
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (U01 AI 50864)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK32493, P30DK057516, P30 DK 57516, R01DK032493, DK-50979, R01DK050979, DK32083)
- 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, early diagnosis, diabetes screening, islet autoantibodies, HLA genotypes, family history of diabetes, HbA1c, insulin dose, glycemic control, growth
- MeSH terms
- Autoantibodies, Child, Colorado, Diabetes Mellitus, Type 1, Follow-Up Studies, Hospitalization, Humans, Infant, Newborn, Mass Screening, Prediabetic State, Treatment Outcome
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