Routine testing for type 1 diabetes in young children could prevent diabetic ketoacidosis, suggest early findings from a JDRF supported study in Bavaria, Germany.
The Fr1da study aims to find out if early detection of type 1 diabetes is feasible across a large population, if such a program could prevent diabetic ketoacidosis, and if early interventions through teaching and emotional support can reduce the psychological stress on families with a type 1 diabetes diagnosis.
The researchers began the study in 2015, and it will span two years. They plan to test 100,000 children between two and five years of age for islet cell autoantibodies. Autoantibodies are produced by the immune system, but attack healthy cells because they are wrongly programmed to consider these cells as dangerous. The presence of two or more islet cell autoantibodies in a child’s blood means they have up to 80% chance of developing type 1 diabetes in childhood.
The hope is that if primary care physicians can identify a risk of type 1 diabetes early by testing for the presence of islet cell autoantibodies, they can prevent diabetic ketoacidosis, a life threatening and quick onset complication that in 30% of cases is the first indication a child has type 1 diabetes.
Initial results were published in BMJ Open Journal in May. They report that in the first 12 months of the study, 26,760 children had been tested for islet autoantibodies, and to date, 63 of the children have been given a pre-diabetes diagnosis.
As part of the study, the families who receive this diagnosis are offered a four hour teaching course on type 1 diabetes and its treatment options, as well as access to counselling. All but two families took up this offer.
There were no cases of diabetic ketoacidosis among the children tested, although it is still unclear whether this is a result of involvement in the Fr1da study, or a general increased awareness about type 1 diabetes among primary care physicians. While there are limits to this study, including testing children at only one point in childhood, and a lack of follow up for children who test positively for just one islet autoantibody (approximately 10% of who will go on to develop type 1 diabetes), the article authors believe that the study could have a big impact on the implementation of type 1 diabetes screening in Germany, and further afield. If the study continues to show similar results in its second year, this method of screening could potentially prevent many children from developing diabetic ketoacidosis by detecting type 1 diabetes earlier, and act as a model for providing families with educational and emotional support to help with this diagnosis.