From the Guidelines
Screening for type 1 diabetes in children is not routinely recommended for the general pediatric population, but should be targeted to children with risk factors, including those with a family history of type 1 diabetes, presence of diabetes-associated autoantibodies, or symptoms suggestive of diabetes, as recommended by the American Diabetes Association 1. When screening is indicated, it typically involves measuring fasting blood glucose, random blood glucose, or hemoglobin A1C levels. For children with symptoms like increased thirst, frequent urination, unexplained weight loss, or fatigue, immediate testing is warranted. The American Diabetes Association suggests that children with multiple first-degree relatives with type 1 diabetes should be considered for screening with islet autoantibody testing, starting at ages 2-5 years with repeat screening every 2 years, as stated in the standards of medical care in diabetes-2021 1. This targeted approach is recommended because type 1 diabetes has a strong genetic component, and early detection can prevent dangerous complications like diabetic ketoacidosis. However, mass screening is not cost-effective or practical since type 1 diabetes affects approximately 1 in 400-500 children and adolescents, and current preventive interventions for those identified as at-risk remain limited. Some key points to consider when screening for type 1 diabetes in children include:
- Screening should be targeted to children with risk factors, including family history, presence of diabetes-associated autoantibodies, or symptoms suggestive of diabetes 1.
- Islet autoantibody testing can be used to screen children with multiple first-degree relatives with type 1 diabetes, starting at ages 2-5 years with repeat screening every 2 years 1.
- Immediate testing is warranted for children with symptoms like increased thirst, frequent urination, unexplained weight loss, or fatigue 1.
- The diagnosis of diabetes must be confirmed by measurement of venous plasma glucose on an analytic instrument in a clinical chemistry laboratory 1. The most recent and highest quality study, standards of care in diabetes-2025 1, provides recommendations for screening and treatment of complications and related conditions in pediatric type 1 diabetes, but does not change the overall approach to screening for type 1 diabetes in children.
From the Research
Screening for Type 1 Diabetes in Kids
- Screening for type 1 diabetes in the general population is a topic of ongoing discussion and research 2
- Most screening programs have targeted relatives of people living with the disease, but recent successes in disease-modifying therapies have ignited consideration of population screening 2
- Existing population screening programs rely on genetic or autoantibody screening, which have yielded significant information about disease progression and approaches for timing screening in clinical practice 2
- Autoantibodies, such as islet cell autoantibodies (ICA), antibodies to insulin (IAA), glutamic acid decarboxylase (GAA or GAD), and protein tyrosine phosphatase (IA2 or ICA512), are associated with the development of type 1 diabetes 3
- The number of antibodies, rather than the individual antibody, is thought to be most predictive of progression to overt diabetes 3
Current Research and Findings
- A 2022 study reviewed the background and details of ongoing efforts for screening in the general population, as well as hurdles that need to be addressed for successful implementation of population screening 2
- A 2020 article summarized diabetes-related concerns that primary care physicians may encounter when caring for children with type 1 diabetes, including understanding of diabetes technology and commonly associated conditions 4
- A 2014 study compared the efficacy of insulin Glargine and Aspart with NPH insulin and regular insulin regimen in children with type 1 diabetes, finding no significant difference in glycemic control or lipid profile between the two regimes 5
Insulin Therapy and Management
- Insulin therapy is used in nearly all people with type 1 diabetes and many people with type 2 diabetes, with the goal of achieving good glycemic control and preventing complications 6
- The choice and management of insulin therapy can be complex, but the broad principles are fairly easily applied in mainstream ambulatory care 6
- Continuous glucose monitoring (CGM) and careful dose adjustment can help mitigate hypoglycemia, a significant issue in type 1 diabetes 6