Intended for healthcare professionals


Screening children for type 1 diabetes

BMJ 2021; 375 doi: (Published 29 December 2021) Cite this as: BMJ 2021;375:e067937
  1. R E J Besser, researcher12,
  2. S M Ng, consultant3 4,
  3. E J Robertson, patient advocate5
  1. 1Department of Paediatrics, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
  2. 2Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
  3. 3Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
  4. 4Department of Paediatrics, Southport and Ormskirk NHS Trust, Southport, UK
  5. 5Diabetes UK, London, UK
  1. Correspondence to: R E J Besser rachel.besser{at}

Worth serious consideration, including further research

Insulin was discovered in 1921, turning a death sentence into a chronic condition, and 100 years later it is still the only treatment for type 1 diabetes. But new approaches are emerging that offer children with this condition a different trajectory.

Type 1 diabetes is caused by autoimmune destruction of the β cells in the pancreatic islets, resulting in insulin deficiency, and is mostly sporadic (>85% of cases). Despite clinical advances, outcomes remain suboptimal, and as many as 70% of children in some countries (25% in the UK, 40% in US) are diagnosed only after life threatening diabetic ketoacidosis.1

The unexpected occurrence of type 1 diabetes causes psychological harm to both children and families, including depression, problems with adjustment, and stress.2 Diabetic ketoacidosis additionally requires costly and intensive hospital management and is associated with serious complications, including cerebral oedema, neurocognitive deficits, shock, and, if untreated, death.1

Evidence is emerging of the benefits of diagnosing children with type 1 diabetes before they experience diabetic ketoacidosis. In an observational study of children and young people with type 1 diabetes …

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