Children as young as two could be given a simple finger-prick test to see if they are at risk of developing type 1 diabetes, and could be started on medication to delay the condition.
A trial in the UK is underway to test the screening process, with 20,000 children being recruited.
Around one in 500 children in the UK has type 1 diabetes and around 25% of those with the condition only receive a diagnosis when they are admitted to hospital with diabetic ketoacidosis (DKA), which is when the blood becomes toxic and can be fatal.
By screening children at risk of type 1 diabetes, the immunotherapy treatment teplizumab could be given to them to slow the progress of the condition. Experts say delaying the onset of type 1 diabetes can reduce the risk of serious complications, including limb amputations, heart and kidney disease and blindness.
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Professor Parth Narendran, from the University of Birmingham, is leading the screening trial and he explained: “There is already evidence from other European studies that screening can reduce the number of DKAs, improve glucose control and mental health. That would save the NHS money.
“But crucially, there are now drugs in development which can delay the onset of diabetes. Hopefully what will happen is long-term delay using sequential therapies. The later someone gets the condition, the easier it may be to manage. And the less damage done in childhood, the better the outcomes may be overall.”
The screening process tests for the rogue immune proteins, autoantibodies. These proteins attack the pancreas cells which are responsible for producing insulin.
The UK trial – called ELSA – involves a simple finger-prick to test the blood, similar to the heel-prick test carried out on newborns to screen for nine serious health conditions.
Children identified in the ELSA trial who test positive for several autoantibodies will undergo more tests to establish their risk of developing type 1 diabetes.
Professor Colin Dayan, from Cardiff University, spoke on the subject at the recent European Association for the Study of Diabetes (EASD) conference, saying children with “two or three” different types of autoantibody were more than 90% more likely to develop type 1 diabetes within 15 years.
The finger-prick test is not currently part of the newborn heel-prick test as the autoantibodies take time to develop. However, this may change, with Professor Narendran saying: “We could do a genetic test as part of the newborn programme to find those at highest risk, then offer them the antibody test when they reach two or three.”
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Diabetes charity JDRF is funding ELSA alongside another charity, Diabetes UK. A spokesman for JDRF said: “We’re hoping this trial will give the Government the evidence it needs to roll out screening for children.”
Dr Emily Sims, associate professor of paediatrics at the Indiana University School of Medicine in America, also spoke at the EASD conference, saying: “Our knowledge of type 1 diabetes has now evolved from thinking it is a disease that suddenly develops to knowing it is something that gradually develops, after the appearance of multiple autoantibodies.
“By screening children and adults to identify individuals with early, pre-symptomatic stages of disease, we can more accurately predict when they will first need insulin and prevent life-threatening DKA episodes.”
Professor Narendran said while the ELSA trial involves children aged from three to 13, they may recruit younger children, explaining: “The German trial looked at screening children aged two to five – we started at three just to give children another year for the autoantibodies to develop. But a lot of families are asking if we could start testing them younger, so we’re going to try to get it down to two.”
Cases of type 1 diabetes in children are on the rise – before the pandemic, rates were increasing by about 3% per year. However, this rose dramatically to 14% in 2020, followed by a further rise of 27% in 2021.
While it is not yet fully understood, experts believe COVID-19 infection may trigger type 1 diabetes.
