ESPEYB17 10. Type 1 Diabetes Mellitus (1) (14 abstracts)
10.14. Yield of a public health screening of children for islet autoantibodies in Bavaria, Germany
Ziegler AG , Kick K , Bonifacio E , Haupt F , Hippich M , Dunstheimer D , Lang M , Laub O , Warncke K , Lange K , Assfalg R , Jolink M , Winkler C , Achenbach P & Fr1da Study Group
To read the full abstract: JAMA. 2020 Jan 28;323(4):339–351. doi: 10.1001/jama.2019.21565. PMID: 31990315
It is unclear how many children in the general population have features of anti-islet cell autoimmunity without later developing type 1 diabetes (T1DM). This public health screening program determined the population prevalence of islet cell autoantibodies (ICA) and the risk for progression to T1DM.
Within this research setting, ICA screening was offered to all children aged 1.75 to 5.99 years in Bavaria, Germany, between 2015 and 2019 by primary care pediatricians during routine well-baby visits. Families of children with multiple ICA were invited to participate in a program of diabetes education, metabolic staging, assessment of psychological stress associated with diagnosis, and prospective follow-up for progression to clinical T1DM until July 31, 2019.
The primary outcomes were presymptomatic T1DM, defined by two or more ICA and categorized into stage 1 (normoglycemia) or stage 2 (dysglycemia), and clinical T1DM (stage 3). Secondary outcomes were diabetic ketoacidosis and parental psychological stress, assessed by the Patient Health Questionnaire-9 (range, 0–27; ≤4 indicates no/minimal depression; >20 indicates severe depression).
Of 90 632 children screened (median [interquartile range {IQR}] age, 3.1 [2.1–4.2] years; 48.5% girls), 280 (0.31%; 95% CI, 0.27–0.35) had presymptomatic T1DM, including 196 (0.22%) with stage 1, 17 (0.02%) with stage 2, 26 (0.03%) with clinical T1DM (and 41 who were not staged). After a median (IQR) follow-up of 2.4 (1.0–3.2) years, another 36 children developed clinical T1DM. The 3-year cumulative risk for clinical T1DM in the 280 children with presymptomatic T1DM was 24.9% ([95% CI, 18.5%–30.7%]; 54 cases; annualized rate 9.0%). Two children had diabetic ketoacidosis. Median (IQR) psychological stress scores were increased at the time of metabolic staging in mothers of children with presymptomatic T1DM (3 [1–7]) compared with mothers of children without ICA (2 [1–4]) (P =0.002), but declined after 12 months of follow-up (2 [0–4]) (P <0.001).
Among children aged 2–5 years in Bavaria, Germany, a program of primary care–based screening showed the prevalence of multiple ICA was 0.31%. These findings have implications for population-based screening of children for ICA in other settings and also for future prevention programs. Unfortunately, previous similar large-scale screening campaigns have not yet led to any real and practical prevention strategy, which implies that measuring ICA alone does not reveal the full picture of prediabetes nor does it necessarily inform prevention strategies and their principles.
Volume 17
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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