Endocrine Abstracts

Aims: Screening for islet autoantibodies identifies individuals with early-stage type 1 diabetes (T1D) who will progress to stage 3, enabling staging, monitoring, support and education to be offered. This systematic review and meta-analysis aims to quantify the effect of screening for T1D on HbA1c, rate of DKA and hospitalisation at diagnosis.

Methods: Data were sourced from CINAHL, MEDLINE, Cochrane Central, Embase, PsychINFO, Web of Science. To be included, studies had to report outcomes of a screened and non-screened group at diagnosis of T1D and include children up to the age of 18. Random effects meta-analyses quantified the mean difference in glycated haemoglobin (HbA1c) and risk ratio (RR) for DKA. Where there was insufficient data (hospitalisation data), a narrative synthesis was undertaken. A risk of bias assessment was performed using the ROBINS-I tool. CRD42023394661

Results: In this study, 8353 studies were identified and 497 underwent full text review. Nine studies (n = 29181 children and young people diagnosed with T1D (screened=730, non-screened=28451)) were included comparing the difference in at least one of HbA1c, DKA, and hospitalisation between a screened and unscreened population. The mean (SD) age was 7.2 (2.6) years at screening. Seven studies reported data for HbA1c, six for DKA and three for hospitalisation. Screening for T1D was associated with a mean reduction in HbA1c at diagnosis of -31.8 mmol/mol [95%CI: -40.5; -23.1] (P <.05), a 34.6% change. The screened population were less likely to develop DKA at diagnosis, RR 0.18 [95%CI: 0.04; 0.44] (P <.05), than the non-screened population. Screening was associated with an absolute risk reduction in DKA at diagnosis of 23.9%. There was insufficient data for a meta-analysis of hospitalisation data, however in the studies retrieved (n = 3) screening was associated with reduced hospitalisation at diagnosis or a reduced mean stay in hospital.

Conclusions: Screening for T1D is associated with a 35% reduction in HbA1c and a risk reduction of 24% for diagnosis in DKA. Improvement in clinical outcomes at diagnosis has important benefits for children with type 1 diabetes, reducing the need for hospitalisation at diagnosis, and the psychological and physiological morbidity associated with DKA. Our study quantifies the benefits of screening.