TrialNet monitoring study shows risk-reducing effect of type 1 diabetes screening
medwireNews: Data from the TrialNet Pathway to Prevention study shows that monitoring high-risk relatives of people with type 1 diabetes markedly reduces the risk for those who develop the condition presenting with diabetic ketoacidosis (DKA).
The findings illustrate the potential benefits of widespread screening for type 1 diabetes, as is being tested in the Fr1da study.
Only one of 54 people being monitored developed DKA, reported Chloe Gillum (University of Bristol, UK) at the Diabetes UK Professional Conference in Liverpool, UK.
This equated to a rate of less 2%, versus a reported 25% of people in the UK having DKA at the point of type 1 diabetes diagnosis, she said.
Gillum described the one person who did develop DKA as a “quiet teenager” living in a busy house with a new baby, suggesting that milder symptoms preceding DKA development may have been missed.
The research team screened 10,320 first- and second-degree relatives for pancreatic autoantibodies and divided the 568 who were positive into risk categories based on the number of autoantibodies, oral glucose tolerance test (OGTT) results, human leukocyte antigen variant, height, weight, and glycated hemoglobin level.
The 238 relatives considered to be at the highest risk who consented to monitoring were assessed twice a year, whereas those at lower risk were assessed annually.
Twenty-six of the 54 people who were subsequently diagnosed with type 1 diabetes had signs or symptoms at diagnosis. The most common signs and symptoms were polyuria, polydipsia, and fatigue, in 22, 19, and 16 people, respectively, with only four and five having polyphagia or weight loss (maximum 2 kg), respectively.
Moreover, glycated hemoglobin was normal (<6%) in over a third, and 28% had a random blood glucose level below 11.1 mmol/L, which is the clinical alert level that triggers the TrialNet researchers to repeat an OGTT.
Eighteen people were hospitalized at the point of diagnosis, one of whom had an overnight stay purely because of hospital policy at the time, and over half were in hospital for only 1–2 days.
Gillum attributed the success of the monitoring to increased awareness, the opportunity for intervention before people developed serious symptoms, and the fact that the study participants were able to adjust to the idea of developing type 1 diabetes before it occurred.
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