Background: Type 1 diabetes (T1D) is the most frequent chronic autoimmune disease in childhood and adolescence, its incidence is increasing particularly in toddlers and preschool children, and up to 60% of young patients present with diabetic ketoacidosis (DKA), a severe and life-threatening complication. So far, the majority of screening efforts have been performed in the at-risk group, i.e., relatives of people with T1D; anyhow, around 90% of young patients who eventually develop T1D do not have a family history. Summary: Some studies in Europe and the USA have clearly shown that a public health screening of children (with positive autoantibodies) is effective in reducing the prevalence of DKA by more than 10 times, decreasing the rate of hospitalization and its costs, providing psychological, emotional, and social support to children and their families. In addition, several treatments and trials are available for children with stage 2 and stage 3 T1D. There is still room for improvement of sensitivity, specificity, positive and negative predictive value in a population screening program; anyhow, there is vivid debate on the opportunity for a screening program in the general population of children at risk for developing T1D. Key Messages: This paper, endorsed by the European Society for Paediatric Endocrinology (ESPE), discusses the issues of a screening program in the general population with the hope that uncertainties and difficulties in this field will be overcome by better screening methods, improved cost-effectiveness, reliable treatments for secondary prevention, and relevant delay in clinically evident T1D in children and adolescents.

1.
Atkinson
MA
,
Eisenbarth
GS
,
Michels
AW
.
Type 1 diabetes
.
Lancet
.
2014
;
383
(
9911
):
69
82
.
2.
Mayer-Davis
EJ
,
Lawrence
JM
,
Dabelea
D
,
Divers
J
,
Isom
S
,
Dolan
L
, et al
.
Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012
.
N Engl J Med
.
2017
;
376
(
15
):
1419
29
.
3.
Cherubini
V
,
Grimsmann
JM
,
Åkesson
K
,
Birkebæk
NH
,
Cinek
O
,
Dovč
K
, et al
.
Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents
.
Diabetologia
.
2020
;
63
(
8
):
1530
41
.
4.
Alonso
GT
,
Coakley
A
,
Pyle
L
,
Manseau
K
,
Thomas
S
,
Rewers
A
, et al
.
Diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado children, 2010–2017
.
Diabetes Care
.
2020
;
43
:
117
21
.
5.
Goldman
S
,
Pinhas-Hamiel
O
,
Weinberg
A
,
Auerbach
A
,
German
A
,
Haim
A
, et al
.
Alarming increase in ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID-19 pandemic in Israel
.
Pediatr Diabetes
.
2022
;
23
:
10
8
.
6.
Duca
LM
,
Wang
B
,
Rewers
M
,
Rewers
A
.
Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control
.
Diabetes Care
.
2017
;
40
(
9
):
1249
55
.
7.
Fredheim
S
,
Johannesen
J
,
Johansen
A
,
Lyngsøe
L
,
Rida
H
,
Andersen
MLM
, et al
.
Diabetic ketoacidosis at the onset of type 1 diabetes is associated with future HbA1c levels
.
Diabetologia
.
2013
;
56
(
5
):
995
1003
.
8.
Barker
JM
,
Goehrig
SH
,
Barriga
K
,
Hoffman
M
,
Slover
R
,
Eisenbarth
GS
, et al
.
Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up
.
Diabetes Care
.
2004
;
27
(
6
):
1399
404
.
9.
Ziegler
AG
,
Rewers
M
,
Simell
O
,
Simell
T
,
Lempainen
J
,
Steck
A
, et al
.
Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children
.
JAMA
.
2013
;
309
(
23
):
2473
.
10.
Bluestone
JA
,
Buckner
JH
,
Herold
KC
.
Immunotherapy: building a bridge to a cure for type 1 diabetes
.
Science
.
2021
;
373
(
6554
):
510
6
.
11.
Ziegler
AG
,
Bonifacio
E
;
BABYDIAB-BABYDIET Study Group
.
Age-related islet autoantibody incidence in offspring of patients with type 1 diabetes
.
Diabetologia
.
2012
;
55
(
7
):
1937
43
.
12.
Insel
RA
,
Dunne
JL
,
Ziegler
AG
.
General population screening for type 1 diabetes: has its time come
.
Curr Opin Endocrinol Diabetes Obes
.
2015
;
22
(
4
):
270
6
.
13.
Ziegler
AG
,
Kick
K
,
Bonifacio
E
,
Haupt
F
,
Hippich
M
,
Dunstheimer
D
, et al
.
Yield of a public health screening of children for islet autoantibodies in Bavaria, Germany
.
JAMA
.
2020
;
323
(
4
):
339
.
14.
Große
J
,
Hornstein
H
,
Manuwald
U
,
Kugler
J
,
Glauche
I
,
Rothe
U
, et al
.
Incidence of diabetic ketoacidosis of new-onset type 1 diabetes in children and adolescents in different countries correlates with human development index (HDI): an updated systematic review, meta-analysis, and meta-regression
.
Horm Metab Res
.
2018
;
50
(
03
):
209
22
.
15.
Rewers
A
,
Dong
F
,
Slover
RH
,
Klingensmith
GJ
,
Rewers
M
.
Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998–2012
.
JAMA
.
2015
;
313
(
15
):
1570
.
16.
Johnson
SB
,
Tercyak
KP
Jr
.
Psychological impact of islet cell antibody screening for IDDM on children, adults, and their family members
.
Diabetes Care
.
1995
;
18
(
10
):
1370
2
.
17.
Hummel
M
,
Ziegler
AG
,
Roth
R
.
Psychological impact of childhood islet autoantibody testing in families participating in the BABYDIAB study
.
Diabet Med
.
2004
;
21
(
4
):
324
8
.
18.
Meehan
C
,
Fout
B
,
Ashcraft
J
,
Schatz
DA
,
Haller
MJ
.
Screening for T1D risk to reduce DKA is not economically viable
.
Pediatr Diabetes
.
2015
;
16
(
8
):
565
72
.
19.
Raab
J
,
Haupt
F
,
Scholz
M
,
Matzke
C
,
Warncke
K
,
Lange
K
, et al
.
Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population: design and initial results of the Fr1da study
.
BMJ Open
.
2016
;
6
(
5
):
e011144
.
20.
McQueen
RB
,
Geno Rasmussen
C
,
Waugh
K
,
Frohnert
BI
,
Steck
AK
,
Yu
L
, et al
.
Cost and cost-effectiveness of large-scale screening for type 1 diabetes in Colorado
.
Diabetes Care
.
2020
;
43
(
7
):
1496
503
.
21.
Samuelsson
U
,
Steineck
I
,
Gubbjornsdottir
S
.
A high mean-HbA1c value 3–15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood: a pilot study using two nation-wide population based quality registries
.
Pediatr Diabetes
.
2014
;
15
(
3
):
229
35
.
22.
Shalitin
S
,
Phillip
M
.
Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age
.
Acta Diabetol
.
2012
;
49
(
5
):
355
62
.
23.
Viswanathan
V
,
Sneeringer
MR
,
Miller
A
,
Eugster
EA
,
DiMeglio
LA
.
The utility of hemoglobin A1c at diagnosis for prediction of future glycemic control in children with type 1 diabetes
.
Diabetes Res Clin Pract
.
2011
;
92
:
65
8
.
24.
Herold
KC
,
Bundy
BN
,
Long
SA
,
Bluestone
JA
,
DiMeglio
LA
,
Dufort
MJ
, et al
.
An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes
.
N Engl J Med
.
2019
;
381
(
7
):
603
13
.
25.
Dayan
CM
,
Korah
M
,
Tatovic
D
,
Bundy
BN
,
Herold
KC
.
Changing the landscape for type 1 diabetes: the first step to prevention
.
Lancet
.
2019
;
394
(
10205
):
1286
96
.
26.
Wilhelm-Benartzi
CS
,
Miller
SE
,
Bruggraber
S
,
Picton
D
,
Wilson
M
,
Gatley
K
, et al
.
Study protocol: minimum effective low dose: anti-human thymocyte globulin (MELD-ATG): phase II, dose ranging, efficacy study of antithymocyte globulin (ATG) within 6 weeks of diagnosis of type 1 diabetes
.
BMJ Open
.
2021
;
11
(
12
):
e053669
.
27.
Besser
REJ
,
Ng
SM
,
Gregory
JW
,
Dayan
CM
,
Randell
T
,
Barrett
T
, et al
.
General population screening for childhood type 1 diabetes: is it time for a UK strategy
.
Arch Dis Child
.
2021
. Epub ahead of print. https://doi.org/10.1136/archdischild-2021-321864.
28.
Sims
EK
,
Besser
RE
,
Dayan
C
,
Geno Rasmussen
C
,
Greenbaum
C
,
Griffin
KJ
, et al
.
Screening for type 1 diabetes in the general population: a status report and perspective
.
Diabetes
.
2022
;
71
(
4
):
610
23
.
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