GAINESVILLE, Fla. – More children should be screened for Type 1 diabetes.
That’s the message from an international team led by University of Florida Health physician-scientist Dr. Michael Haller, who is chief of pediatric endocrinology in the UF College of Medicine’s Department of Pediatrics and a member of the UF Diabetes Institute.
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Haller and his team recently developed new treatment guidelines that say children and adolescents in the general population should be screened for Type 1 diabetes before they have symptoms.
That would include screening the young relatives -- like siblings -- of those with Type 1 diabetes because they are at higher genetic risk of developing diabetes.
The guidelines cover screening, staging, and strategies to preserve beta cell function in children and adolescents with Type 1 diabetes.
They were published last month in the journal Hormone Research in Paediatrics and are issued under the umbrella of the International Society for Pediatric and Adolescent Diabetes, or ISPAD.
The set of guidelines covers about 20 different aspects of diabetes care and is periodically updated by ISPAD. They play a major role in guiding treatment for millions of people globally.
“Type 1 diabetes affects 1 in 300 people, so it’s not a rare disease,” Haller said. “It’s probably the second-most common chronic disease of childhood after asthma.
“We’ve known for several decades the disease can be identified early on. The big challenge is that we really didn’t have anything we could do about it other than monitor those children and see them continue to progress toward Type 1 diabetes.”
That, however, is no longer the case.
In late 2022, the U.S. Food and Drug Administration approved a drug therapy called teplizumab that can delay the progression of the disease by an average of up to two years in certain high-risk patients.
UF Health participates in TrialNet, an international research consortium to prevent Type 1 diabetes, and was one of the major clinical trial sites for its work on teplizumab.
“Teplizumab is a major change for the field and one that now justifies offering screening to a much larger number of people now that we have the means to delay disease progression,” Haller said.
Early detection of Type 1 diabetes dramatically lowers the risk of complications at diagnosis, which is especially true of underserved populations who historically face a higher risk of diabetic ketoacidosis at diagnosis, Haller said.
Diabetic ketoacidosis is a complication of diabetes in which a lack of insulin ultimately leads to an increase of life-threatening acids, called ketones, in the blood.
He also noted that screening children outside of first-degree relatives who have Type 1 diabetes will require educating more family practice doctors and general pediatricians about what they can do with the data.
“That’s only going to underscore the shortage of pediatric endocrinologists,” Haller said.
“We’re a very small subspecialty and it’s becoming increasingly challenging to recruit people into the field. We need to shine a light on the need for more people to come into the field. We need to inspire the next generation of future doctors to pursue careers in pediatric endocrinology.”
Doing that, he added, might require state and federal policies to incentivize physicians into entering the field.
Haller said the UF Diabetes Institute is probably among the top five centers globally investigating Type 1 diabetes.
“We have an incredible research team that spans the entire spectrum, from very basic science to very translational work,” he said.
“We’re going to continue to do those things nationally and internationally with the hope of ultimately developing therapies that can durably prevent the disease and maybe one day even reverse it.”
Dr. Laura Jacobsen, an assistant professor in the UF College of Medicine’s Department of Pediatrics and a UF Diabetes Institute researcher, also contributed to the ISPAD guidelines.