Presentation and characteristics of children with screen-detected type 1 diabetes: learnings from the ELSA general population pediatric screening study.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Lauren M Quinn, Renuka P Dias, Christopher Bidder, Sudeshna Bhowmik, Kerstin Bumke, Jaikumar Ganapathi, Shaun Gorman, Edward Hind, Swati Karandikar, Kiran Kumar, Nicholas Lipscomb, Sheila McGovern, Vijith R Puthi, Tabitha Randell, Gemma Watts, Parth Narendran
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Abstract

Introduction: We describe the identification and management of general population screen-detected type 1 diabetes (T1D) and share learnings for best practice.

Research design and methods: Children diagnosed with T1D through a general population screening initiative, the EarLy Surveillance for Autoimmune diabetes (ELSA) study, were reviewed and described.Parents provided written, informed consent for inclusion in the case series.

Results: 14 children with insulin requiring (stage 3) T1D are described. These cases offer unique insights into the features of screen-detected T1D. T1D is identified sooner through screening programs, characterized by absent/short symptom duration, median presenting glycated hemoglobin 6.6% (49 mmol/mol) and insulin requirements<0.5 units/kg/day. ELSA identified four children at stage 3 and another 4 progressed within 4 months of ELSA completion, including two single seropositive children. Six children developed stage 3 T1D prior to ELSA completion, including two children (14%, n=2/14) with diabetic ketoacidosis prior to confirmed antibody status.

Conclusions: There are three main learnings from this case series. First, T1D identified through screening is at an earlier stage of its natural history and requires personalized insulin regimens with lower total daily insulin doses. Second, single autoantibody seropositivity can rapidly progress to stage 3. Finally, insulin requirement can manifest at any stage of the T1D screening pathway, and therefore early education around symptom recognition is essential for families participating in screening programs.

筛查出的 1 型糖尿病患儿的表现和特征:从 ELSA 普通人群儿科筛查研究中汲取的经验。
介绍:我们介绍了普通人群筛查出的 1 型糖尿病(T1D)的识别和管理,并分享了最佳实践的经验:对通过普通人群筛查计划--自体免疫性糖尿病早期监测(ELSA)研究--确诊为T1D的儿童进行回顾和描述:结果:描述了 14 名需要胰岛素治疗(3 期)的 T1D 患儿。这些病例为了解筛查出的 T1D 的特征提供了独特的见解。T1D通过筛查项目较早被发现,其特点是无症状/症状持续时间短,出现糖化血红蛋白的中位数为6.6%(49 mmol/mol),需要胰岛素治疗:本系列病例有三大启示。首先,通过筛查发现的 T1D 处于自然病程的早期阶段,需要采用个性化的胰岛素治疗方案,降低胰岛素的日总剂量。其次,单一自身抗体血清阳性可迅速发展到第三阶段。最后,胰岛素需求可在 T1D 筛查过程中的任何阶段出现,因此,对于参与筛查项目的家庭来说,围绕症状识别的早期教育至关重要。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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