Objective: Detection of pre-symptomatic T1D by islet autoantibody (IA) screening prevents hospitalization and diabetic ketoacidosis at clinical onset. It is unknown if presence of diabetic symptoms and random blood glucose predict islet autoantibodies. We report the efficacy of random blood glucose (RBG) measurement, among those who reported multiple symptoms for T1D, for detecting T1D autoimmunity.
Methods: In 2017-18, the Autoimmunity Screening for Kids (ASK) study screened 14,418 Denver children 1-17 y old for autoantibodies to insulin, GAD, IA-2, and ZnT8. At the time of screening, the parent and/or child were asked whether or not the child had increased urination, thirst, weight loss or vomiting in the last 3 months. If two or more symptoms were reported, RBG was tested using a glucometer and IA testing was fast-tracked with results available in <7 days.
Results: Of the children screened, 0.9% were positive for multiple IA or a single high-affinity IA conferring, respectively, a 44% and 29% 5-year risk of clinical T1D. A fast-track protocol with RBG testing was applied to 501/12,726 children screened between 6/2017-12/2018, flagged for priority testing. Ten (2%) of the 501 fast-track participants had multiple or single high-affinity IA, compared to 91/12,050 (0.8%) IA in those with one or no symptoms (p=0.002). At screening, children found later to have multiple or high-affinity IA more often reported ≥2 symptoms: 9.6% (10/104) compared with low-affinity IA, 4.3% (11/254, p=0.05), or negative, 4.9% (602/12,368, p=0.03). Among those with increased thirst and polyuria, 16/358 (4.5%) had IA. For IA positive, none reported all symptoms (12 IA neg reported all symptoms). RBG>140 mg/dl was detected in 1/14 (7.1%) children with multiple symptoms and IA vs. 15/440 (3.4%) children with symptoms and no IA (p=0.5). None had RBG>200.
Conclusions:Symptoms history is helpful but RBG is not, in finding children with pre-symptomatic T1D.
K. Waugh: None. B.I. Frohnert: None. M. Rewers: None. J. Baxter: None. C.R. Geno Rasmussen: None.