Screening of pre-type 1 diabetes in high-risk paediatric population: a pilot study in Latvia
摘要
The incidence of type 1 diabetes (T1D) among the paediatric population in Latvia is gradually increasing, and ~ 50% of patients with newly diagnosed T1D present with diabetic ketoacidosis (DKA). This study aimed to initiate T1D screening for high-risk children to reduce the rate of DKA and enable early pre-symptomatic intervention. This prospective observational study was conducted at Children’s Clinical University Hospital (CCUH) from March 2024 to February 2026. Siblings aged 2–17 years of patients with T1D were invited to participate. The parents completed a short questionnaire regarding participants’ health status and family history. Screening was performed in two stages: (1) 3-screen ELISA and insulin autoantibody (IAA) ELISA testing; if ≥ 1 positive then (2) ELISA testing for all four autoantibodies (AAs) separately: IAA, insulinoma-associated antigen-2 (IA-2A), zinc transporter 8 (ZnT8A) and glutamic acid decarboxylase 65 (GAD-65A) antibodies, glycaemic status assessment, and screening for celiac disease and autoimmune thyroiditis. Participants with ≥ 2 AAs in the second screening underwent a 2 h-oral glucose tolerance test (OGTT). Parents of participating children were screened for anxiety and depression using GAD-7 (general anxiety disorder 7) and PHQ-9 (patient health questionnaire-9) instruments. Of the 83 participants in the first screening, 26 (31.3%) had ≥ 1 positive test results. This group more frequently had ≥ 1 family member with T1D than those with negative results (30.8 versus 5.3% respectively, p = 0.003). In the second screening stage, 13 participants (50%) tested negative for all 4 AAs, 9 (10.8%) had one positive AA (AA +), one participant had two AA + , and three children had three AA + . At the time of the second screening, all participants had normal glycaemic measurements, negative results for celiac disease and autoimmune thyroiditis screening. During observation period, two participants developed stage 3 T1D. Following the OGTT, another participant was diagnosed with stage 2 T1D, but two other participants with ≥ 2 AA + remained normoglycemic. The overall prevalence of depression and anxiety was similarly high among parents of children with both positive and negative T1D screening results; however, parents in the positive screening group more frequently exhibited severe anxiety.
Conclusion: Positive T1D screening with ≥ 2 AAs was observed in 5 (6.02%) participants. Three participants progressed to stage 2 or stage 3 T1D during follow-up, corresponding to a positive predictive value of 60%, within a relatively short observation period of 10–24 months. These findings support the implementation of T1D screening in Latvia, particularly in high-risk populations.