June 12, 2024

Screening children for type 1 diabetes – The BMJ

0

R E J Besser, researcher12, S M Ng, consultant3 4, E J Robertson, patient advocate51Department of Paediatrics, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK2Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK3Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK4Department of Paediatrics, Southport and Ormskirk NHS Trust, Southport, UK5Diabetes UK, London, UKCorrespondence to: R E J Besser rachel.besser{at}ouh.nhs.u…….

  1. R E J Besser, researcher12,
  2. S M Ng, consultant3 4,
  3. E J Robertson, patient advocate5
  1. 1Department of Paediatrics, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
  2. 2Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
  3. 3Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
  4. 4Department of Paediatrics, Southport and Ormskirk NHS Trust, Southport, UK
  5. 5Diabetes UK, London, UK
  1. Correspondence to: R E J Besser rachel.besser{at}ouh.nhs.uk

Worth serious consideration, including further research

Insulin was discovered in 1921, turning a death sentence into a chronic condition, and 100 years later it is still the only treatment for type 1 diabetes. But new approaches are emerging that offer children with this condition a different trajectory.

Type 1 diabetes is caused by autoimmune destruction of the β cells in the pancreatic islets, resulting in insulin deficiency, and is mostly sporadic (>85% of cases). Despite clinical advances, outcomes remain suboptimal, and as many as 70% of children in some countries (25% in the UK, 40% in US) are diagnosed only after life threatening diabetic ketoacidosis.1

The unexpected occurrence of type 1 diabetes causes psychological harm to both children and families, including depression, problems with adjustment, and stress.2 Diabetic ketoacidosis additionally requires costly and intensive hospital management and is associated with serious complications, including cerebral oedema, neurocognitive deficits, shock, and, if untreated, death.1

Evidence is emerging of the benefits of diagnosing children with type 1 diabetes before they experience diabetic ketoacidosis. In an observational study of children and young people with type 1 diabetes from the US (n=3364), diabetic ketoacidosis at diagnosis was associated with worse glycaemic outcomes—a risk factor for long term complications—over 15 years of follow-up.3 A more recent study of young people with diabetes (n=57 000) showed that absence of diabetic ketoacidosis at diagnosis predicted fewer episodes of severe hypoglycaemia and ketoacidosis after 10 years.4 However, confounding by contributory factors cannot be excluded.

Children who develop type 1 diabetes have more frequent contact with health services in the year before diagnosis, yet the condition is often missed.5 Campaigns to increase public and professional awareness have had minimal success.6 A different strategy is needed, …….

Source: https://www.bmj.com/content/375/bmj-2021-067937

Leave a Reply

Your email address will not be published. Required fields are marked *