Australia could be first to adopt routine childhood screening for type 1 diabetes

A new national screening research pilot for type 1 diabetes funded by JDRF and led by a team at the University of Sydney is launching in locations across the country this month.

If the pilot is successful, Australia could become the first country to adopt routine childhood screening to detect type 1 diabetes in children.

Type 1 diabetes (T1D) is a lifelong autoimmune condition that occurs when the immune system mistakenly attacks the insulin-producing cells in the pancreas. It is frequently diagnosed in children and adolescents, with three Australian children diagnosed each day.

Current diagnosis of T1D happens too late, with 1 in 3 Australian children not diagnosed until they require emergency care as the first signs and symptoms of T1D, like tiredness and excessive thirst, can be easily missed or mistaken for other minor childhood concerns.

Ninety per cent of those diagnosed have no family history of T1D, meaning routine childhood screening is the only way to identify most children at risk of the condition.

Screening for T1D has been shown to support earlier diagnosis, prior to a child showing clinical signs of the condition or presenting with diabetic ketoacidosis (DKA), a life-threatening diabetes complication that requires admission to intensive care.

The University of Sydney’s Dr Kirstine Bell, the Principal Research Fellow leading the program, says that the Type 1 Diabetes National Screening Pilot being launched will help determine how to best implement screening in Australia, while identifying those who have early-stage type 1 diabetes.

“The pilot program will be rolled out across five states throughout the coming months, to compare differing screening methods, including dried bloodspot testing in newborns and older children and saliva samples in infants. Each method is simple, safe, effective and will be provided at no cost to families in the pilot locations,” said Dr Bell from the University’s Charles Perkins Centre.

“The findings will give us the evidence base to determine the most appropriate model for adoption in Australia and provide families who participate the benefits of early detection, which can help avoid critical illness and DKA at the point of diagnosis, improve long-term disease outcomes and provide access to the right resources and support at the right time.”

This type of screening is only possible due to a new T1D staging classification that identifies two early, pre-symptomatic stages (stages 1 and 2) of T1D that mark the onset of the condition rather than the previously late and symptomatic diagnosis (stage 3), when the insulin-producing cells in the pancreas have already been destroyed.8 Stages 1 and 2 T1D can be present for months or years prior to onset of symptoms and can be detected through simple screening.

Most children who are screened will receive a normal test result. For those who are identified with early-stage type 1 diabetes, they are likely to still feel perfectly well with no symptoms and will be referred to a childhood diabetes specialist for ongoing care and monitoring.

This detection and specialist referral is important for families as studies show that for those diagnosed with stages 1-2, the vast majority will progress to symptomatic, insulin dependent T1D before adulthood.

The pilot program is funded by JDRF, the leading non-government funder of T1D research globally.

JDRF Chief Scientific Officer, Dr Dorota Pawlak, says that early detection is an essential step in the T1D journey and opens avenues to intercept the condition further down the track.

“The Type 1 Diabetes National Screening Pilot is a very exciting advancement for T1D research that could enable population-wide early detection and provide opportunities for preventative interventions.

“While there is not yet a cure for type 1 diabetes, alongside projects for early detection, JDRF are also investing in a number of research projects that investigate how to delay or prevent the onset of symptomatic T1D during the early stages of the condition.

“The screening rollout would mean that participants who are identified with early-stage type 1 diabetes could be offered enrolment into clinical trials for preventative treatments, which if successful, could become available more widely to anyone who needs them.”

The Type 1 Diabetes National Screening Pilot is aiming to make early type 1 diabetes detection available for every child in Australia.

If this type of screening was adopted into the Australian healthcare system, the trajectory of T1D care could be transformed and put Australia in good stead to become the leader for T1D care internationally.