Toddlers to be given routine finger-prick blood test to flag up their risk of developing type 1 diabetes

Tests could allow medics to treat young children before they develop the disease
Sufferers must inject regular doses of insulin to prevent diabetic ketoacidosis

Toddlers could be given a routine finger-prick blood test to flag up their risk of developing type 1 diabetes – and given drugs to delay the condition.

The problem, which affects one in 500 children in Britain, occurs when the immune system mistakenly attacks cells in the pancreas, stopping it from producing the hormone insulin which keeps blood sugar levels stable.

Sufferers must inject regular doses of insulin to stay alive and prevent diabetic ketoacidosis, or DKA – a life-threatening condition when the blood becomes toxic.

About a quarter of children with type 1 are diagnosed only after being admitted to hospital with DKA. But identifying children as young as two who are at risk of diabetes via a blood test – and before they have dangerous symptoms – means new drugs such as immunotherapy treatment teplizumab could be used. This protects cells in the pancreas and delays the development of the condition. It could also prevent hundreds of DKA episodes a year.

Diagnosing type 1 diabetes at an earlier stage will make the condition easier to manage

According to experts, this delay may reduce the risk of major complications from type 1 diabetes such as limb amputations, heart and kidney disease and blindness, and may make the condition easier to manage in the long term.

Type 1 diabetes specialist Professor Parth Narendran, from the University of Birmingham, is leading a trial recruiting 20,000 children to evaluate the screening method. He said: ‘There is already evidence from other European studies that screening can reduce the number of DKAs, improve glucose control and mental health. That would save the NHS money.

‘But crucially, there are now drugs in development which can delay the onset of diabetes. Hopefully what will happen is long-term delay using sequential therapies. The later someone gets the condition, the easier it may be to manage. And the less damage done in childhood, the better the outcomes may be overall.’

The finger-prick test looks for rogue immune proteins called autoantibodies, which attack the insulin-producing pancreas cells.

Speaking at the European Association for the Study of Diabetes (EASD) conference, Professor Colin Dayan, from Cardiff University, said children with ‘two or three’ different types of autoantibody were over 90 per cent more likely to develop type 1 diabetes within 15 years.

The UK screening study, called ELSA, involves simply testing a spot of blood from a child’s finger – much like the routine newborn heel-prick test which looks for nine life-limiting conditions.

Children who test positive for several autoantibodies will then have further tests to determine if they are at risk of the disease.

These rogue proteins develop over time, which is why it is currently not being trialled as part of the newborn heel-prick test. But this could change.

‘We could do a genetic test as part of the newborn programme to find those at highest risk, then offer them the antibody test when they reach two or three,’ Prof Narendran says.

Prior to the Covid-19 pandemic, type 1 diabetes incidence in children was increasing by roughly three per cent per year. This increased significantly to 14 per cent in the first year of the pandemic (2020), followed by a further 27 per cent increase in 2021.

The rise suggests infection with Covid-19 may trigger the development of type 1 diabetes, although this is not fully understood.

Five years ago, epidemiologists forecast that there would be 33,100 children and adolescents (ages 0–19) with type 1 diabetes in the UK in 2023, which was expected to increase to 33,800 by 2029. This year, it’s likely cases will top 35,000 and experts now say far more than anticipated will have the disease by the end of the decade.

Dr Emily Sims, associate professor of paediatrics at the Indiana University School of Medicine in the US, told the EASD conference: ‘Our knowledge of type 1 diabetes has now evolved from thinking it is a disease that suddenly develops to knowing it is something that gradually develops, after the appearance of multiple autoantibodies.

‘By screening children and adults to identify individuals with early, pre-symptomatic stages of disease, we can more accurately predict when they will first need insulin and prevent life-threatening DKA episodes.’

It is understood that there is an ‘ongoing dialogue’ with the Government’s National Screening Committee about the possibility of screening for type 1 diabetes.

A spokesman for type 1 diabetes charity JDRF, which is funding ELSA alongside charity Diabetes UK, said: ‘We’re hoping this trial will give the Government the evidence it needs to roll out screening for children.’

The ELSA study is recruiting children aged three to 13 for screening, but Prof Narendran says younger children may be able to join.

He adds: ‘The German trial looked at screening children aged two to five – we started at three just to give children another year for the autoantibodies to develop. But a lot of families are asking if we could start testing them younger, so we’re going to try to get it down to two.’

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