Type 1 diabetes

National Type 1 Diabetes Screening Program pilot announced


Dr Kirstine Bell

Preventing the risk of DKA at diagnosis is one of the major goals of the Australian Type 1 Diabetes National Screening Program pilot which will start recruiting in April 2022.

Dr Kristine Bell, principal research fellow on the program, told the Australasian Diabetes Congress 2021 that general population screening was essential given that 90% of newly diagnosed type 1 diabetes have no affected first degree relative.

She said 1 in 3 children currently present with DKA at diagnosis but there was evidence that risk was even higher in younger children and in regional areas.

“Screening prevents DKA at diagnosis,” she said.

Preventing DKA at diagnosis also had the potential to weaken the association with impaired cognitive structure and function, increased risk of subsequent DKA, higher HbA1c, and increased risk of long-term diabetes complications.

The national pilot is designed to answer questions about which types of screening were feasible and acceptable in the community, as well as efficacious and cost effective.

Three screening models will be tested in different parts of Australia with two combining both a genetic risk score with autoantibody monitoring.

One model will use a sample from the current newborn heel prick testing and a second model will involve saliva swabs from infants. Depending on their genetic risk score, infants will have no further follow-up or receive regular monitoring from about 1 year of age.

A third screening model will skip the genetic risk assessment and instead test only for autoantibodies in two finger prick samples at about 2 and 5 years of age.

Speaking to the limbic after her presentation, Dr Bell said the program was focussed on clinical care of children identified at risk, with stage 1 or 2 presymptomatic diabetes or type 1 diabetes.

“The first thing is to smooth their introduction to type 1 diabetes and prevent DKA. If one in three kids, potentially even more, are getting DKA at diagnosis and that has a long term health impact, then that is something worthwhile we can do straight away.”

“We don’t need to wait for trials, which are super important and our long term vision, but immediately we can do something with a meaningful impact.”

She said many of the collaborators on the pilot program were already embedded in other programs such as ENDIA, Type1 Screen, Type 1 Diabetes TrialNet, and the Australasian Diabetes Data Network (ADDN).

“Although we have them under different headings as each has a particular focus, we are not duplicating and we are sharing knowledge between them all.”

Dr Bell said families would have the option for a smooth transition from the screening program into say an immunotherapy trial to prevent or delay type 1 diabetes for those who would like to join.

Stakeholder mapping and engagement with communities such as Indigenous and non-English speaking people would also get underway.

“The first question to get a national program underway is how to do screening. The pilot is designed to ask which model works best in Australia. Once we know that, we can run towards the final goal of a national program.”

Dr Bell has been announced as the ADS Lindsey Baudinet Rising Star Award in Type 1 Diabetes 2021.

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