ASK the Experts support for
WHY SCREEN FOR EARLY TYPE 1 DIABETES (T1D)
T1D affects at least 1% of the general population children. Patients often experience delay in care and complications because 92% have no family history of these diseases. In 2015, the American Diabetes Association, JDRF, and Endocrine Society released T1D staging guidelines in an effort to identify pre-symptomatic disease toward prevention of diabetic ketoacidosis (DKA) at onset and to provide patients with opportunities to participate in interventions and clinical trials that may delay or prevent disease.
Stage 1 T1D is defined by the presence of two or more islet autoantibodies (IAA, GADA, IA-2A or ZnT8A) and normal blood glucose levels. It is associated with a 44% 5-year risk and a 70%, 10-year risk of clinical diabetes. Without an effective intervention, stage 1 T1D is currently considered a ‘point of no return’. Children progress to Stage 2 T1D, i.e., asymptomatic dysglycemia and Stage 3 - symptomatic diabetes - with a lifetime risk approaching 100%. ASK defines pre-stage 1 T1D as the persistent presence of a single high-affinity islet autoantibody.
Prospective studies of high-risk children have led to consensus that pre-symptomatic T1D in children should be identified early to educate caregivers regarding symptoms of hyperglycemia and allow timely diagnosis before onset of potentially fatal DKA. Diabetes awareness and minimal home blood glucose monitoring can prevent >80% of hospitalizations for DKA, including life threatening complications, e.g., cerebral edema. During the past decade, the proportion of children presenting with DKA in Colorado, and possibly throughout the U.S., has increased from 46% to 58%. An estimated 120 children in the U.S. die every year as the result of delayed diagnosis of T1D. Prevention of DKA at diagnosis improves long-term glycemic control, and decreases the risk of vascular complications and memory deficits.