Screening Children for Early-Stage Type 1 Diabetes

Winkler C, Friedl N, Abt R, Ackermann K, Bently J, Braig S, Brämswig S, Dunstheimer D, Ermer U, Ewald D, Gerstl EM, Hammersen J, Haupt F, Hergl M, Hubmann M, Hummel S, Jochem B, Knopff A, Lange K, Lwowsky D, Nellen-Hellmuth N, Prey B, Rettner D, Schill S, Schmidt S, Scholz M, Sindichakis M, Stock J, Stricker D, Völkl TM, Warncke K, Weber L, Weiss A, Bonifacio E, Achenbach P, Ziegler AG (2026)

Publication Type: Journal article

Publication year: 2026

Journal

DOI: 10.1001/jama.2026.6085

Abstract

Importance Detecting type 1 diabetes in presymptomatic stages is essential for therapies aimed at delaying clinical onset. Objective To estimate early-stage (stage 1 or 2) type 1 diabetes prevalence and disease progression to clinical (stage 3) type 1 diabetes in children in a population-based screening study. Design, Setting, and Participants From February 2015 to July 2025, children living in Bavaria, Germany, were screened for early-stage type 1 diabetes. Screening was conducted by 716 primary care pediatricians. Screening was performed once in children aged 1.75 to 5.99 years until March 2019 and was subsequently expanded to include up to 2 screenings in children aged 1.75 to 10.99 years. Families of children with early-stage disease were offered diabetes education, metabolic staging, and longitudinal monitoring in 18 specialized diabetes centers. Exposures Measurement of islet autoantibodies. Main Outcomes and Measures The primary outcome was early-stage type 1 diabetes, defined as 2 or more autoantibodies against insulin, glutamic acid decarboxylase, islet antigen-2, or zinc transporter 8 confirmed in consecutive blood samples, with categorization into stages 1 (normoglycemia) and 2 (dysglycemia) and progression to clinical (stage 3) diabetes. Results Among 220 476 enrolled children (median [IQR] age, 3.1 [2.2-5.0] years; 106 952 [48.7%] females), 590 had presymptomatic early-stage type 1 diabetes at first screening (adjusted population frequency, 0.3% [95% CI, 0.28%-0.32%]) with prevalences of 0.23% for stage 1 and 0.06% for stage 2 type 1 diabetes. Repeat screening in 11 726 children after a median of 3.3 years identified 29 additional cases. During a median follow-up of 5.7 years, 212 children with an early-stage diagnosis at first screening, 5 with a diagnosis at rescreening, and 43 without an early-stage diagnosis developed clinical (stage 3) diabetes. Five-year progression from early-stage to clinical diabetes was 36.2% (95% CI, 31.2%-40.8%; annualized rate, 9.6%), and not significantly different between children with and without a first-degree family history (P =.54). Conclusions and Relevance General population screening of children identified early-stage type 1 diabetes and similar progression rates to clinical diabetes between children with and without a first-degree family history. These findings inform disease-modifying therapy trials and suggest that screening can be considered beyond genetically selected populations.

Involved external institutions

Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (HMGU) / Helmholtz Munich Germany (DE) Kinder- und Jugendärzte Wendelstein Germany (DE) Klinikum Nürnberg Germany (DE) Klinikum Bayreuth Germany (DE) RoMed Kliniken - Kliniken der Stadt und des Landkreises Rosenheim GmbH Germany (DE) Universitätsklinikum Augsburg Germany (DE) KJF Klinik St. Elisabeth Germany (DE) Klinikum Dritter Orden Germany (DE) Kliniken Südostbayern AG Germany (DE) Josefinum Augsburg Germany (DE) Technische Universität München (TUM) Germany (DE) Klinikverbund Allgäu Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Leopoldina Krankenhaus Schweinfurt Germany (DE) Klinikum St. Marien Amberg Germany (DE) Kinderärzte Zirndorf Germany (DE) Deutsches Zentrum für Diabetesforschung e.V. (DZD) Germany (DE)

How to cite

APA:

Winkler, C., Friedl, N., Abt, R., Ackermann, K., Bently, J., Braig, S.,... Ziegler, A.G. (2026). Screening Children for Early-Stage Type 1 Diabetes. Journal of the American Medical Association. https://doi.org/10.1001/jama.2026.6085

MLA:

Winkler, Christiane, et al. "Screening Children for Early-Stage Type 1 Diabetes." Journal of the American Medical Association (2026).

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