Childhood screening for type 1 diabetes ‘effective and workable’

New research has shown support for a national childhood screening programme for type 1 diabetes – and diabetes specialist nurses say they would be ‘at the forefront’ of delivering the initiative in the community.

Led by researchers at the University of Birmingham, early results from the ELSA (Early Surveillance for Autoimmune diabetes), have shown that childhood screening for type 1 diabetes, including at GP surgeries and schools, is ‘effective’ and would help ‘dramatically reduce’ emergency diagnoses.

‘A major step forwards’

Researchers say the findings mark a ‘major step towards a future in which type 1 diabetes can be detected in children before symptoms appear’.

The study, funded by diabetes charities and understood to be the first UK study of its kind, tested blood samples from 17,931 children aged three to 13 for islet autoantibodies that are markers of type 1 diabetes that can appear years before symptoms.

Published in The Lancet Diabetes & Endocrinology, the researchers explained that children without these autoantibodies are unlikely to develop type 1 diabetes, while those with one autoantibody have a 15% chance of developing the condition within 10 years.

If a child has two or more autoantibodies, this indicates the immune system has already started attacking the insulin-producing cells in the pancreas and it is almost certain these children will eventually need insulin therapy – and is known as early-stage type 1 diabetes.

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As part of the study, 17,283 children aged three to 13 years, were screened for their risk of type 1 diabetes by providing a capillary dried blood spot sample, either self-collected at home or through a GP practice, school or hospital setting.

Results showed:

• 75 had one autoantibody, signalling increased future risk
• 160 had two or more autoantibodies but did not yet require insulin therapy, indicating early-stage type 1 diabetes
• Seven were found to have undiagnosed type 1 diabetes with all needing to start insulin immediately.

During the study, families of children found to have early-stage type 1 diabetes received tailored education and ongoing support to prepare for the eventual onset of type 1 diabetes symptoms and to ensure insulin therapy can begin promptly when needed. Those with one autoantibody also received ongoing support and monitoring.

Some of the families were also offered treatment for their child with the drug teplizumab, which can delay the need for insulin by around three years.

Those behind the research suggested that families were happy to take part in type 1 diabetes screening, with more than 37,000 families already signed up to the study.

Researchers also explored the emotional impact of screening and identified that many parents initially felt anxious when their child screened positive for autoantibodies.

However, it also suggested that education and ongoing monitoring and support helped families feel more informed and prepared for the eventual progression of type 1 diabetes.

Importantly, researchers stressed that early detection can ‘dramatically reduce’ emergency diagnoses and could give children access to new immunotherapy treatments – like teplizumab – that can delay the need for insulin for years.

‘A screening programme is workable in the real world’

Diabetes UK, which helped funding the study, said the findings show that a type 1 diabetes childhood screening programme ‘is workable in the real world’.

Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, said the research was ‘generating the evidence needed to make type 1 diabetes screening a reality for every family in the UK’.

‘For too many families, a child’s type 1 diabetes diagnosis still comes as a frightening emergency. But that doesn’t have to be the case,’ she said.

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‘Thanks to scientific breakthroughs, we now have the tools to identify children in the very earliest stages of type 1 diabetes – giving families precious time to prepare, avoid emergency hospital admissions, and access treatments that can delay the need for insulin for years.’

Lead researcher, Parth Narendran, Professor of diabetes Medicine at the University of Birmingham, added that the team was ‘working towards a future where type 1 diabetes can be detected in a timely manner, and families appropriately supported and treated with medicines to delay the need for insulin’.

‘Nursing input is a cornerstone of safe diabetes care’

Clinical lead diabetes specialist and co-chair of the Diabetes Specialist Nurse Forum UK, Bethany Kelly, told Nursing in Practice that the findings ‘highlight a transformative moment for Type 1 diabetes care in the UK’.

‘The evidence clearly shows that childhood screening is both effective and essential, with the potential to prevent thousands of emergency diagnoses by identifying the condition long before symptoms develop,’ she said.

Ms Kelly added: ‘As diabetes specialist nurses, we will be at the forefront of delivering this new era of proactive care.’

She explained that the role of diabetes specialist nurses would be central in ‘supporting families through education, helping them understand autoantibody results, early‑stage Type 1 diabetes, and what to expect’.

In addition, they would be involved in providing regular monitoring and screening appointments and ensuring children identified as at risk or in early‑stage disease are reviewed ‘closely and compassionately’.

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Diabetes specialist nurses would also support by offering ‘continuity and reassurance’, she said, and would help guide families through potential immunotherapy pathways.

‘The ELSA study’s success demonstrates strong public support for screening and highlights how specialist nursing input will remain a cornerstone of safe, person‑centred diabetes care as the programme expands,’ added Ms Kelly.

‘As diabetes specialist nurses, we are committed to ensuring everyone receiving this diagnosis receives the knowledge, care, and support they need – long before symptoms ever appear.’

Next steps for the study will see research on how screening can be scaled across the NHS and an evaluation of its cost-effectiveness.