Endocrine Abstracts

2021 is an important year for diabetes. It is 100 years since insulin was discovered and the first child had their life saved by insulin, turning a death sentence into a chronic condition. Since then, insulin has remained the mainstay of treatment for type 1 diabetes. Outcomes have improved with advances in technology, but outcomes remain suboptimal and, in the UK, around 25% children still present late, in a state of life-threatening diabetic ketoacidosis (DKA). DKA rates have remained unchanged for at least the last 20 years. DKA can cause significant morbidity (cerebral oedema, neurocognitive deficits, shock), and is associated with chronic hyperglycaemia, a predictor of long-term complications. If undiagnosed or complicated, DKA can be fatal. A new diagnosis is typically unexpected and, even in the absence of DKA, is traumatic for children and families, causing depression, problems with adjustment, and stress. It is now possible to identify children with type 1 diabetes before they develop symptoms through measurement of islet-specific antibodies. This offers hope to minimise acute presentations and the rate of DKA at diagnosis. In future it will allow children to access disease-modifying therapies to delay the need for insulin therapy. Since more than 85% newly diagnosed patients do not have a family history of type 1 diabetes, to make an impact on new diagnoses, a general population approach is needed. However, before screening is introduced, the balance of benefit and harm needs to be determined. In this session, I will present the case for national screening for pre-clinical type 1 diabetes and discuss what we need to know before embarking on a national screening strategy.