{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:42:25Z","timestamp":1791978145429,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"\n Importance<\/jats:title>\n Detecting type 1 diabetes in presymptomatic stages is essential for therapies aimed at delaying clinical onset.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate early-stage (stage 1 or 2) type 1 diabetes prevalence and disease progression to clinical (stage 3) type 1 diabetes in children in a population-based screening study.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n From February 2015 to July 2025, children living in Bavaria, Germany, were screened for early-stage type 1 diabetes. Screening was conducted by 716 primary care pediatricians. Screening was performed once in children aged 1.75 to 5.99 years until March 2019 and was subsequently expanded to include up to 2 screenings in children aged 1.75 to 10.99 years. Families of children with early-stage disease were offered diabetes education, metabolic staging, and longitudinal monitoring in 18 specialized diabetes centers.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Measurement of islet autoantibodies.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was early-stage type 1 diabetes, defined as 2 or more autoantibodies against insulin, glutamic acid decarboxylase, islet antigen-2, or zinc transporter 8 confirmed in consecutive blood samples, with categorization into stages 1 (normoglycemia) and 2 (dysglycemia) and progression to clinical (stage 3) diabetes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 220\u202f476 enrolled children (median [IQR] age, 3.1 [2.2-5.0] years; 106\u202f952 [48.7%] females), 590 had presymptomatic early-stage type 1 diabetes at first screening (adjusted population frequency, 0.3% [95% CI, 0.28%-0.32%]) with prevalences of 0.23% for stage 1 and 0.06% for stage 2 type 1 diabetes. Repeat screening in 11\u202f726 children after a median of 3.3 years identified 29 additional cases. During a median follow-up of 5.7 years, 212 children with an early-stage diagnosis at first screening, 5 with a diagnosis at rescreening, and 43 without an early-stage diagnosis developed clinical (stage 3) diabetes. Five-year progression from early-stage to clinical diabetes was 36.2% (95% CI, 31.2%-40.8%; annualized rate, 9.6%), and not significantly different between children with and without a first-degree family history (\n P<\/jats:italic>\n \u2009=\u2009.54).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n General population screening of children identified early-stage type 1 diabetes and similar progression rates to clinical diabetes between children with and without a first-degree family history. These findings inform disease-modifying therapy trials and suggest that screening can be considered beyond genetically selected populations.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04039945<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.6085","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:00:31Z","timestamp":1779375631000},"page":"2046","source":"Crossref","is-referenced-by-count":9,"title":["Screening Children for Early-Stage Type 1 Diabetes"],"prefix":"10.1001","volume":"335","author":[{"given":"Christiane","family":"Winkler","sequence":"first","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany"},{"name":"German Center for Diabetes Research (DZD), Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Friedl","sequence":"additional","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Abt","sequence":"additional","affiliation":[{"name":"Kinder- und Jugend\u00e4rzte Wendelstein, Wendelstein, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Ackermann","sequence":"additional","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Bently","sequence":"additional","affiliation":[{"name":"Nuremberg Hospital South, Nuremberg, 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Jugendmedizin, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva-Maria","family":"Gerstl","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Dritter Orden, Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Hammersen","sequence":"additional","affiliation":[{"name":"University Hospital, Department of Pediatrics, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Haupt","sequence":"additional","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany"},{"name":"German Center for Diabetes Research (DZD), Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Hergl","sequence":"additional","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, 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Lappersdorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Knopff","sequence":"additional","affiliation":[{"name":"Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Lange","sequence":"additional","affiliation":[{"name":"Hannover Medical School, Department of Medical Psychology, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Lwowsky","sequence":"additional","affiliation":[{"name":"Kinder- und Jugend\u00e4rzte Wendelstein, Wendelstein, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Nellen-Hellmuth","sequence":"additional","affiliation":[{"name":"MVZ and Hospital Leopoldina, Schweinfurt, 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