3 Australian children are diagnosed with type 1 diabetes every day.
A late diagnosis can be life-threatening, but screening can find kids early, before they start developing symptoms.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease which destroys insulin-producing beta-cells in the pancreas, leading to a complete absence of insulin production. It is most commonly diagnosed in children and young adults, with the peak incidence between 10-14 years of age.
Management is complex, requiring life-long insulin therapy to maintain blood glucose levels within the narrow limits of normal blood glucose levels and avoid acute, hypo- and hyperglycaemia. Glycaemic control outside recommended targets is closely linked with serious diabetes complications, including amputation, blindness, kidney failure and cardiovascular disease.
Stages of type 1 diabetes
There are 2 presymptomatic stages of type 1 diabetes that can be present for months or years.
Type 1 diabetes has traditionally been thought to have a severe, rapid onset. However, it is now evident that there are two silent, presymptomatic stages that mark the onset of type 1 diabetes and can be present for months or even years prior to traditional symptomatic diagnosis.
Until a preventative therapy can be made available, 85% of children with early stage, presymptomatic type 1 diabetes will progress to Stage 3 in childhood, with a lifetime risk approaching 100%.
Stage 1: The appearance of multiple islet autoantibodies marks the onset of type 1 diabetes and the start of the autoimmune destruction of the insulin-producing -cells. However, blood glucose levels remain within normal limits as sufficient -cells are still present.
Stage 2: becomes evident as blood glucose levels begin to rise. As the -cells are progressively destroyed, blood glucose levels may meet the diagnostic thresholds for ‘Impaired fasting glucose’ and/or ‘impaired glucose tolerance’.NOTE: These two conditions are usually linked with insulin resistance and the development of type 2 diabetes. This is a different pathophysiology & clinical pathway to type 1 diabetes).
Stage 3: is the traditional clinical diagnostic point, when the majority of the -cells have been destroyed and blood glucose levels are above the clinical diagnostic levels. Children usually develop severe symptoms very quickly and are immediately reliant on insulin therapy for survival.
Why screen for type 1 diabetes?
With a simple test, the ‘Type 1 Diabetes National Screening Pilot’ can help find children as early as possible, avoid the trauma of a missed diagnosis, and support families in every way possible.
A missed diagnosis can be life-threatening
At least 1 in 3 Australian children are diagnosed with type 1 diabetes too late, presenting to emergency departments with diabetic ketoacidosis (DKA), a life-threatening build-up of glucose and acidic ketones in the blood which, if left untreated, can cause coma and death. Treatment of DKA requires admission to intensive care, expensive high-level medical care and causes significant post-traumatic stress for families.
There are no early warning signs and first symptoms are vague
Type 1 diabetes doesn’t become symptomatic until the condition has already reached stage 3 and the vast majority of β-cells have been destroyed. Even then, diagnosis is often delayed as 90% have no family history of the condition and the first signs and symptoms of type 1 diabetes are vague and easily missed.
Common symptoms of type 1 diabetes include increased thirst and urination, fatigue and weight loss.
Screening can identify children early and improve health outcomes
Childhood screening for type 1 diabetes can virtually eliminate the risk of DKA at diagnosis (<5% in international trials) because it catches the disease in its infancy (stages 1 and 2). This can have immediate and long-term health benefits, including reduced risk of recurrent DKA and cognitive impairment, lower glycaemia control and increased risk of diabetes-related blindness and kidney disease from early adulthood.
Prevention is on the horizon
Screening for presymptomatic type 1 diabetes also creates the window of opportunity to prevent or at least delay the progression of the condition to insulin requiring stage 3 type 1 diabetes.
The first therapy, teplizumab, is seeking FDA approval after a landmark study showed it could delay Stage 3 type 1 diabetes by a median of 3 years in initial results.
Click on the map to find out about screening in your state
The Type 1 Diabetes National Screening Pilot aims to find the best way to offer screening for type 1 diabetes to children in Australia.
This national 'not for profit' research pilot is led by the University of Sydney, with collaborating universities and hospitals around Australia. It is funded by JDRF, a research foundation for type 1 diabetes.
