Protection through early knowledge: clinical onset of type 1 diabetes in children and adolescents with and without early T1D detection programmes

To compare the clinical status at the start of insulin therapy between children with classic type 1 diabetes manifestation (T1D) and those identified early through population-based autoantibody screening. The classic T1D cohort included all children and adolescents diagnosed at the Children’s Hospital AUF DER BULT in Hanover, Germany, between July 2021 and December 2024. The comparison cohort consisted of children who progressed to stage 3 T1D during follow-up in the Fr1dolin or Fr1da Northern Germany autoantibody screening programmes between August 2017 and December 2024. Analysed variables included age, sex, family history of T1D (FDR), metabolic parameters on admission (pH, bicarbonate, HbA1c) and duration of hospitalisation. A total of 323 children had classic T1D onset, and 26 progressed to stage 3 after early-stage detection through screening. Screen-detected children were younger at diagnosis and showed lower glucose and HbA1c levels, higher pH values, and no diabetic ketoacidosis. Their hospital stays were shorter. Multiple regression analysis showed that participation in an early detection programme (ß=-0.178, 95% CI -5.817 to -1.371, p=0.002) significantly predicted HbA1c at onset, whereas age (p=0.377) and FDR status did not (p=0.137). These findings demonstrate that participation in early type 1 diabetes autoantibody screening programmes is associated with a more favourable clinical status at the time of stage 3 diagnosis. They emphasise the importance of early detection in terms of preventive strategies, clinical management and health economics.