Presymptomatic Type Research Articles

Discrimination and precision of Continuous Glucose Monitoring in staging children with presymptomatic type 1 diabetes.

Staging and monitoring of pre-symptomatic type 1 diabetes includes the assessment for dysglycemia. To assess the ability of Continuous Glucose Monitoring (CGM) to differentiate between islet autoantibody-negative controls and early-stage type 1 diabetes and explore whether CGM classifiers predict progression to clinical diabetes. Children and adolescents participating in public health screening for islet autoantibodies in Bavaria, Germany were invited to undergo CGM with Dexcom G6. In total, 118 participated and valid data was obtained from 97 (57 female; median age 10 [range 3-17] years), including 46 with stage 1, 18 with stage 2, and 33 with no islet autoantibodies. Mean glucose during CGM in islet autoantibody-negative controls was high (median, 115.3 mg/dl) and varied substantially (IQR, 106.8-124.4). Eleven (33%) of the controls had more than 10% of glucose values above 140 mg/dl (TA140). Using thresholds corresponding to 100% specificity in controls, differences between controls and stage 1 and stage 2 were obtained for glucose standard deviation, TA140, TA160 and TA180. Elevations in any two of these parameters identified 12 (67%) with stage 2 and 9 (82%) of 11 participants who developed clinical diabetes within one year. However, there was marked variation within groups for all parameters and poor consistency observed in a second CGM performed in 18 participants. This study demonstrated the potential of integrating CGM into staging and monitoring of early-stage type 1 diabetes. However, substantial improvement in the precision of CGM is required for its application in routine monitoring practices.

Endocrinology: Updated ICD-10-CM Diabetes and Hypoglycemia Codes

This article reviews code changes that will be implemented for services on and after October 1, 2024. Topics addressed in this article include the following: Presymptomatic type 1 diabetes (T1D)Hypoglycemia levels

Establishing clinical follow-up in early-stage pre-symptomatic type 1 diabetes: results from the oxford pre-T1D clinical service

Establishing clinical follow-up in early-stage pre-symptomatic type 1 diabetes: results from the oxford pre-T1D clinical service

Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children.

One third of Australian children diagnosed with type 1 diabetes present with life-threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early-stage, presymptomatic type 1 diabetes, with ongoing follow-up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus on the optimal approach. This pilot study aims to assess three models for a routine, population-wide screening programme in Australia. An implementation science-guided pilot study to evaluate the feasibility, acceptability and costs of three screening models in children will be conducted between July 2022 and June 2024. These models are as follows: (1) Genetic risk-stratified screening using newborn heel prick dried bloodspots, followed by autoantibody testing from 11 months of age; (2) genetic risk-stratified screening of infant (6-12 months) saliva followed by autoantibody testing from 10 months of age; and (3) autoantibody screening using capillary dried bloodspots collected from children aged 2, 6 or 10 years. Cohorts for each model will be recruited from targeted geographic areas across Australia involving ≥2 states per cohort, with a recruitment target of up to 3000 children per cohort (total up to 9000 children). The primary outcome is screening uptake for each cohort. Secondary outcomes include programme feasibility, costs, parental anxiety, risk perception, satisfaction, well-being and quality of life, and health professional attitudes and satisfaction. This pilot is the first direct comparison of three screening implementation models for general population screening. Findings will provide evidence to inform a potential national screening programme for Australian children. ACTRN12622000381785.

Early Dysglycemia Is Detectable Using Continuous Glucose Monitoring in Very Young Children at Risk of Type 1 Diabetes.

Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 10 years. Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched control children underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time >7.8 mmol/L (>140 mg/dL) were determined and examined for between-group differences. The mean (SD) ages of PM Ab+ and Ab- children were 4.4 (1.8) and 4.7 (1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median (quartile 1 [Q1], Q3) sensor wear period of 12.5 (9.0, 15.0) days. PM Ab+ children had higher median (Q1, Q3) SDSGL (1.1 [0.9, 1.3] vs. 0.9 [0.8, 1.0] mmol/L; P < 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P < 0.001). Percentage of time >7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab- children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10). CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time >7.8 mmol/L, consistent with prior studies involving older participants.

Universal screening for early detection of chronic autoimmune, metabolic and cardiovascular diseases in the general population using capillary blood (UNISCREEN): low-risk interventional, single-centre, pilot study protocol

IntroductionChronic autoimmune (type 1 diabetes and coeliac disease) and metabolic/cardiovascular (type 2 diabetes, dyslipidaemia, hypertension) diseases are highly prevalent across all age ranges representing a major public health burden. Universal...

Advances in risk predictive performance of pre-symptomatic type 1 diabetes via the multiplex Antibody-Detection-by-Agglutination-PCR assay.

Achieving early diagnosis of pre-symptomatic type 1 diabetes is critical to reduce potentially life-threatening diabetic ketoacidosis (DKA) at symptom onset, link patients to FDA approved therapeutics that can delay disease progression and support novel interventional drugs development. The presence of two or more islet autoantibodies in pre-symptomatic type 1 diabetes patients indicates high-risk of progression to clinical manifestation. Herein, we characterized the capability of multiplex ADAP assay to predict type 1 diabetes progression. We obtained retrospective coded sera from a cohort of 48 progressors and 44 non-progressors from the NIDDK DPT-1 study. The multiplex ADAP assay and radiobinding assays had positive predictive value (PPV)/negative predictive value (NPV) of 68%/92% and 67%/66% respectively. The improved NPV stemmed from 12 progressors tested positive for multiple islet autoantibodies by multiplex ADAP assay but not by RBA. Furthermore, 6 out of these 12 patients tested positive for multiple islet autoantibodies by RBA in subsequent sampling events with a median delay of 2.8 years compared to multiplex ADAP assay. In summary, multiplex ADAP assay could be an ideal tool for type 1 diabetes risk testing due to its sample-sparing nature (4µL), non-radioactiveness, compatibility with widely available real-time qPCR instruments and favorable risk prediction capability.

Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes.

Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies. The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented. As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.

Identification of Immune Gene Signature Associated with T Cells and Natural Killer Cells in Type 1 Diabetes.

This study aimed to investigate the abnormal infiltration of immune cells in type 1 diabetes mellitus (T1D) and elucidate their regulatory mechanisms. Public T1D-related gene expression data were obtained from the Gene Expression Omnibus database.The GSE123658 dataset analyzed whole blood RNA-seq data from type 1 diabetic patients and healthy volunteers. The GSE110914 dataset analyzed neutrophils purified from peripheral blood of patients with symptomatic and pre-symptomatic type 1 diabetes (T1D), at risk of T1D, and healthy controls. Immune cell infiltration analysis was performed to identify abnormally infiltrating immune cells. Differentially expressed immune genes (DEIGs) in T1D samples were identified, followed by the construction of an immune gene signature (IGS) using a protein-protein interaction (PPI) network and Least absolute shrinkage and selection operator Cox regression analyses (LASSO Cox regression analyses). The regulatory mechanisms underlying IGS were explored using gene set enrichment analysis. Furthermore, expression validation, diagnostic efficacy evaluation, and upstream miRNA prediction of hub signature genes were performed. We verified the miRNA expression of the key gene colony stimulating factor 1 (CSF1) and microRNA-326 (miR-326) by reverse transcription-quantitative PCR (RT‒qPCR). The proportion of infiltrating T and natural killer (NK) cells differed between the T1D and control samples, and 207 immune genes (IGs) related to these immune cells were extracted. After differential expression, PPI, and LASSO Cox regression analyses, four signature DEIGs were identified for IGS construction: notch receptor 1 (NOTCH1), Janus kinase 3 (JAK3), tumor necrosis factor receptor superfamily member 4(TNFRSF4), and CSF1. Key pathways such as the Toll-like receptor signaling pathway were significantly activated in the high-risk group. Moreover, the upregulation of CSF1 in T1D samples was confirmed using a validation dataset, and CSF1 showed high diagnostic efficacy for T1D. Furthermore, CSF1 was targeted by miR-326.We used validated key genes in T1D patients, several of which were confirmed by RT‒qPCR. In conclusion, the identified key IGs may play an important role in T1D. CSF1 can be developed as a novel diagnostic biomarker for T1D.

EarLy Surveillance for autoimmune type 1 diabetes - paediatric screening in the UK.

Children with pre-symptomatic type 1 diabetes can be identified through testing for circulating islet autoantibodies. Identifying children at risk reduces the rates of diabetic ketoacidosis at presentation and allows participation in clinical trials for type 1 diabetes prevention. The Early Surveillance for Autoimmune diabetes study (ELSA) is exploring feasibility and acceptability of UK paediatric general population screening. The ELSA study runs from July 2022 to August 2024 and aims to recruit 20 000 children aged 3-13 years. ELSA is screening for islet autoantibodies via dried blood spot (DBS) and subsequent staging via oral glucose tolerance testing. ELSA is exploring feasibility and acceptability of UK paediatric general population screening. At the time of writing, 2582 children have been consented to the study. In the preliminary beta version (July-October 2022), there were 59 expressions of interest, 37 children consented (63%) and 22 kits returned (59%). Of the consented children, 17 families were invited and 8 were passive recruits through friends/family. Reasons for not returning the kit included issue with home-testing (n=1) and concern about the lancet (n=1). One of the DBS kits screened positive (4.5%), but the serum confirmation did not detect autoantibodies. The study launched nationally via social media on 14 November 2022 (World Diabetes Day) leading to a surge in expressions of interest (n=3070). Of these, 2141 children were consented within 36 hours. Social media has been an effective route to recruitment. Community outreach to schools and general practices will be implemented as this study evolves, to explore optimal recruitment modalities and acceptability.

Continuous glucose monitoring has an increasing role in pre-symptomatic type 1 diabetes: advantages, limitations, and comparisons with laboratory-based testing.

Type 1 diabetes (T1D) is well-recognised as a continuum heralded by the development of islet autoantibodies, progression to islet autoimmunity causing beta cell destruction, culminating in insulin deficiency and clinical disease. Abnormalities of glucose homeostasis are known to exist well before the onset of typical symptoms. Laboratory-based tests such as the oral glucose tolerance test (OGTT) and glycated haemoglobin (HbA1c) have been used to stage T1D and assess the risk of progression to clinical T1D. Continuous glucose monitoring (CGM) can detect early glycaemic abnormalities and can therefore be used to monitor for metabolic deterioration in pre-symptomatic, islet autoantibody positive, at-risk individuals. Early identification of these children can not only reduce the risk of presentation with diabetic ketoacidosis (DKA), but also determine eligibility for prevention trials, which aim to prevent or delay progression to clinical T1D. Here, we describe the current state with regard to the use of the OGTT, HbA1c, fructosamine and glycated albumin in pre-symptomatic T1D. Using illustrative cases, we present our clinical experience with the use of CGM, and advocate for an increased role of this diabetes technology, for monitoring metabolic deterioration and disease progression in children with pre-symptomatic T1D.

Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation.

We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes.

Paving the way for evidence-based population screening for type 1 diabetes.

Since the 1980s, we have been gaining knowledge about the pathogenesis of type 1 diabetes and found that the measurement of diabetes-associated autoantibodies against insulin, glutamic acid decarboxylase, insulinoma-associated protein 2, and zinc transporter 8 has a central role in recognition of early stages of the disease in asymptomatic people. In the 1990s, large prospective studies were established in Finland (the Diabetes Prediction and Prevention [DIPP] study 1 Kupila A Muona P Simell T et al. Feasibility of genetic and immunological prediction of type I diabetes in a population-based birth cohort. Diabetologia. 2001; 44: 290-297 Crossref PubMed Scopus (268) Google Scholar ), Germany (the BABYDIAB study 2 Ziegler AG Hummel M Schenker M Bonifacio E Autoantibody appearance and risk for development of childhood diabetes in offspring of parents with type 1 diabetes: the 2-year analysis of the German BABYDIAB study. Diabetes. 1999; 48: 460-468 Crossref PubMed Scopus (536) Google Scholar ), Sweden (Diabetes Prediction in Skåne Study 3 Elding Larsson H A Swedish approach to the prevention of type 1 diabetes. Pediatr Diabetes. 2016; 17: 73-77 Crossref PubMed Scopus (13) Google Scholar ), and the USA (the Diabetes Autoimmunity Study in the Young [DAISY] 4 Rewers M Bugawan TL Norris JM et al. Newborn screening for HLA markers associated with IDDM: Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia. 1996; 39: 807-812 Crossref PubMed Scopus (349) Google Scholar ) that followed up children with a high genetic risk of developing type 1 diabetes from birth until diagnosis of clinical type 1 diabetes. On the basis of these findings, confirmed positivity for multiple (at least two) autoantibodies predicts almost inevitable progression to clinical type 1 diabetes within 15 years from seroconversion 5 Insel RA Dunne JL Atkinson MA et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015; 38: 1964-1974 Crossref PubMed Scopus (473) Google Scholar and thus allows the diagnosis before clinical symptoms develop. However, the disease's progression shows a high variability and mostly depends on the age at which seroconversion occurs, with prechoolers having a faster decline of residual β-cell function than adolescents. Therefore, to better understand the interaction between genetics and environmental factors in children with a high genetic risk of type 1 diabetes, further large prospective studies, such as TEDDY 6 TEDDY Study GroupThe Environmental Determinants of Diabetes in the Young (TEDDY) study: study design. Pediatr Diabetes. 2007; 8: 286-298 Crossref PubMed Scopus (219) Google Scholar or Diabetes Evaluation in Washington (DEW‑IT), 7 Wion E Brantley M Stevens J et al. Population-wide infant screening for HLA-based type 1 diabetes risk via dried blood spots from the public health infrastructure. Ann NY Acad Sci. 2003; 1005: 400-403 Crossref PubMed Scopus (24) Google Scholar were established in the USA in the early 2000s. Although maximum autoantibody conversion occurs between the first and second year of life, approximately 20% of children develop multiple antibodies after 5 years of age. Islet autoantibody screening in at-risk adolescents to predict type 1 diabetes until young adulthood: a prospective cohort studyScreening of adolescents at risk for type 1 diabetes only once at 10 years of age for islet autoantibodies was highly effective to detect type 1 diabetes by the age of 18 years, which in turn could enable prevention of diabetic ketoacidosis and participation in secondary prevention trials. Full-Text PDF

Methylglyoxal products in pre-symptomatic type 1 diabetes.

Progression to type 1 diabetes has emerged as a complex process with metabolic alterations proposed to be a significant driver of disease. Monitoring products of altered metabolism is a promising tool for determining the risk of type 1 diabetes progression and to supplement existing predictive biomarkers. Methylglyoxal (MG) is a reactive product produced from protein, lipid, and sugar metabolism, providing a more comprehensive measure of metabolic changes compared to hyperglycemia alone. MG forms covalent adducts on nucleic and amino acids, termed MG-advanced glycation end products (AGEs) that associate with type 1 diabetes. We tested their ability to predict risk of disease and discriminate which individuals with autoimmunity will progress to type 1 diabetes. We measured serum MG-AGEs from 141 individuals without type 1 diabetes and 271 individuals with type 1 diabetes enrolled in the Fr1da cohort. Individuals with type 1 diabetes were at stages 1, 2, and 3. We examined the association of MG-AGEs with type 1 diabetes. MG-AGEs did not correlate with HbA1c or differ between stages 1, 2, and 3 type 1 diabetes. Yet, RNA MG-AGEs were significantly associated with the rate of progression to stage 3 type 1 diabetes, with lower serum levels increasing risk of progression. MG-AGEs were able to discriminate which individuals with autoantibodies would progress at a faster rate to stage 3 type 1 diabetes providing a potential new clinical biomarker for determining rate of disease progression and pointing to contributing metabolic pathways.

Screening children for presymptomatic type 1 diabetes.

Screening children for presymptomatic type 1 diabetes.

SARS-CoV-2 Seroprevalence in Preschool and School-Age Children.

The SARS-CoV-2 pandemic is ongoing in Germany. Children and adolescents are increasingly being infected, and many cases presumably remain undetected and unreported. Sero-epidemiological studies can help estimate the true number of infections. From January 2020 to June 2022, 59 786 persons aged 1-17 years were tested for SARS-CoV-2 antibodies as part of a screening program for presymptomatic type 1 diabetes in the German federal state of Bavaria (the Fr1da study). In June 2022, the seroprevalence in the overall population was 73.5%. The seroprevalence was significantly higher in school-age children (from 5 to 10 years of age) than in preschool children (ages 1-4): 84.4% vs. 66.6%, p <0.001. In contrast, in November 2021, before the appearance of the omicron variant, the overall seroprevalence was 14.7% (16.2% of school-age children, 13.0% of preschool children, p = 0.06). In the overall collective, seroprevalence increased fivefold from the fall of 2021 to June 2022 (by a factor of 5.2 in school-age children and 5.1 in preschool children). Similar seroprevalences, with smaller case numbers, were observed in June 2022 in the corresponding Fr1da studies in Saxony and Northern Germany: 87.8% and 76.7%, respectively. Monthly case counts reveal a substantial rise in SARS-CoV-2-infections among children and adolescents from late 2021 to mid-2022. The high percentage of preschool and school-age children who have been infected with SARS-CoV-2, in a population that has low vaccination coverage, should be taken into account in the development of health policies.

Progression likelihood score identifies substages of presymptomatic type 1 diabetes in childhood public health screening

Aims/hypothesisThe aim of this study was to develop strategies that identify children from the general population who have late-stage presymptomatic type 1 diabetes and may, therefore, benefit from immune intervention.MethodsWe tested children from Bavaria, Germany, aged 1.75–10 years, enrolled in the Fr1da public health screening programme for islet autoantibodies (n=154,462). OGTT and HbA1c were assessed in children with multiple islet autoantibodies for diagnosis of presymptomatic stage 1 (normoglycaemia) or stage 2 (dysglycaemia) type 1 diabetes. Cox proportional hazards and penalised logistic regression of autoantibody, genetic, metabolic and demographic information were used to develop a progression likelihood score to identify children with stage 1 type 1 diabetes who progressed to stage 3 (clinical) type 1 diabetes within 2 years.ResultsOf 447 children with multiple islet autoantibodies, 364 (81.4%) were staged. Undiagnosed stage 3 type 1 diabetes, presymptomatic stage 2, and stage 1 type 1 diabetes were detected in 41 (0.027% of screened children), 30 (0.019%) and 293 (0.19%) children, respectively. The 2 year risk for progression to stage 3 type 1 diabetes was 48% (95% CI 34, 58) in children with stage 2 type 1 diabetes (annualised risk, 28%). HbA1c, islet antigen-2 autoantibody positivity and titre, and the 90 min OGTT value were predictors of progression in children with stage 1 type 1 diabetes. The derived progression likelihood score identified substages corresponding to ≤90th centile (stage 1a, n=258) and >90th centile (stage 1b, n=29; 0.019%) of stage 1 children with a 4.1% (95% CI 1.4, 6.7) and 46% (95% CI 21, 63) 2 year risk of progressing to stage 3 type 1 diabetes, respectively.Conclusions/interpretationPublic health screening for islet autoantibodies found 0.027% of children to have undiagnosed clinical type 1 diabetes and 0.038% to have undiagnosed presymptomatic stage 2 or stage 1b type 1 diabetes, with 50% risk to develop clinical type 1 diabetes within 2 years.Graphical abstract

SARS-CoV-2 Infections and Presymptomatic Type 1 Diabetes Autoimmunity in Children and Adolescents From Colorado, USA, and Bavaria, Germany

This study screens more than 50 000 youths in diverse populations of Colorado and Bavaria to assess whether previous SARS-CoV-2 infection was associated with autoimmunity, which predicts future type 1 diabetes.

Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry.

To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes. Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status. In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0-22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0-29.3] vs. 22.7% [21.4-24.0], P < 0.001, or vs. 24.3% [22.9-25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization. This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.

IDF21-0304 ELSA Study: EarLy Surveillance for Autoimmune diabetes in the UK

Background: Multiple autoantibody testing identifies children with pre-symptomatic type 1 diabetes (T1D) and is able to stratify those at risk over a 10–15-year period. Identifying children at risk reduces the rates of DKA at presentation and allows them to participate in clinical trials for T1D prevention. T1D general population testing programmes have been trialled in the US and Germany and found a pre-symptomatic T1D rate of 0.3%, achieved a reduction in diabetic ketoacidosis rates from 20% to 5%, and were considered acceptable to families.