Zum Inhalt springen

Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany

  • von
  • 1. Dezember 20214. Dezember 2021

Anette-Gabriele Ziegler, MD; Kerstin Kick, PhD; Ezio Bonifacio, PhD; Florian Haupt, PhD; Markus Hippich, PhD; Desiree Dunstheimer, MD; Martin Lang, MD; Otto Laub, MD; Katharina Warncke, MD; Karin Lange, PhD; Robin Assfalg, PhD; Manja Jolink, MSc; Christiane Winkler, PhD; Peter Achenbach, MD; for the Fr1da Study Group

JAMA. 2020;323(4):339-351. doi:10.1001/jama.2019.21565

IMPORTANCE Public health screening for type 1 diabetes in its presymptomatic stages may reduce disease severity and burden on a population level.

OBJECTIVE To determine the prevalence of presymptomatic type 1 diabetes in children participating in a public health screening program for islet autoantibodies and the risk for progression to clinical diabetes.

DESIGN, SETTING, AND PARTICIPANTS Screening for islet autoantibodies was offered to children aged 1.75 to 5.99 years in Bavaria, Germany, between 2015 and 2019 by primary care pediatricians during well-baby visits. Families of children with multiple islet autoantibodies (presymptomatic type 1 diabetes) were invited to participate in a program of diabetes education, metabolic staging, assessment of psychological stress associated with diagnosis, and prospective follow-up for progression to clinical diabetes until July 31, 2019.

EXPOSURES Measurement of islet autoantibodies.

MAIN OUTCOMES AND MEASURES The primary outcome was presymptomatic type 1 diabetes, defined by 2 or more islet autoantibodies, with categorization into stages 1 (normoglycemia), 2 (dysglycemia), or 3 (clinical) type 1 diabetes. Secondary outcomes were the frequency of diabetic ketoacidosis and parental psychological stress, assessed by the Patient Health Questionnaire-9 (range, 0-27; higher scores indicate worse depression; 4 indicates no to minimal depression; >20 indicates severe depression).

RESULTS Of 90 632 children screened (median [interquartile range {IQR}] age, 3.1 [2.1-4.2] years; 48.5% girls), 280 (0.31%; 95% CI, 0.27-0.35) had presymptomatic type 1 diabetes, including 196 (0.22%) with stage 1, 17 (0.02%) with stage 2, 26 (0.03%) with stage 3, and 41 who were not staged. After a median (IQR) follow-up of 2.4 (1.0-3.2) years, another 36 children developed stage 3 type 1 diabetes. The 3-year cumulative risk for stage 3 type 1 diabetes in the 280 children with presymptomatic type 1 diabetes was 24.9% ([95% CI, 18.5%-30.7%]; 54 cases; annualized rate, 9.0%). Two children had diabetic ketoacidosis. Median (IQR) psychological stress scores were significantly increased at the time of metabolic staging in mothers of children with presymptomatic type 1 diabetes (3 [1-7]) compared with mothers of children without islet autoantibodies (2 [1-4]) (P = .002), but declined after 12 months of follow-up (2 [0-4]) (P < .001).

CONCLUSIONS AND RELEVANCE Among children aged 2 to 5 years in Bavaria, Germany, a program of primary care–based screening showed an islet autoantibody prevalence of 0.31%. These findings may inform considerations of population-based screening of children for islet autoantibodies.

Fazit:

Sicherlich ein wichtiger Ansatz und für die betroffenen Kinder extrem wichtig. Wie hoch der Nutzen ist, ist noch nicht klar. Der potentielle Schaden muss bedacht werden. Eine Beachtung von Risikofaktoren kann den potentiellen Schaden reduzieren.

Fazit Regen:

In der Leitlinie wird angeführt, dass ein generelles Screening auf Typ 1-Diabetes weder in der Allgemeinheit noch in Risikogruppen empfohlen wird. Als Nebenwirkung muss man die Verunsicherung der Eltern bedenken.