Type 1 diabetes (T1D) is the most frequent chronic autoimmune disease in childhood and adolescence, its incidence is increasing particularly in toddlers and preschool children, and up to 60% of young patients present with diabetic ketoacidosis (DKA), a severe and life-threatening complication. So far, the majority of screening efforts have been performed in at risk group, i.e. relatives of people with T1D; anyhow, around 90% of young patients who eventually develop T1D do not have a family history. Some studies in Europe and the USA have clearly shown that a public health screening of children (with positive autoantibodies) is effective in reducing the prevalence of DKA by more than 10 times, decreasing the rate of hospitalization and its costs, providing psychological, emotional and social support to children and their families. In addition, several treatments and trials are available for children with stage 2 and stage 3 T1D. There is still room for improvement of sensitivity, specificity, positive and negative predictive value in a population screening program; anyhow, there is vivid debate on the opportunity for a screening program in the general population of children at risk for developing T1D. This paper, endorsed by the European Society for Paediatric Endocrinology (ESPE), discusses the issues of a screening program in the general population with the hope that uncertainties and difficulties in this field will be overcome by better screening methods, improved cost/effectiveness, reliable treatments for secondary prevention and relevant delay in clinically evident T1D in children and adolescents.


中文翻译：

---

筛查普通人群儿童的胰岛自身抗体：欧洲儿科内分泌学会认可的立场声明

1 型糖尿病 (T1D) 是儿童和青春期最常见的慢性自身免疫性疾病，其发病率特别是在幼儿和学龄前儿童中呈上升趋势，高达 60% 的年轻患者出现糖尿病酮症酸中毒 (DKA)，这是一种严重的终生疾病。威胁并发症。到目前为止，大多数筛查工作都是在高危人群中进行的，即 T1D 患者的亲属；无论如何，大约 90% 最终发展为 T1D 的年轻患者没有家族史。欧洲和美国的一些研究清楚地表明，对儿童（自身抗体阳性）进行公共卫生筛查可以有效地将 DKA 的患病率降低 10 倍以上，降低住院率及其成本，提供心理、情感和对儿童及其家庭的社会支持。此外，一些治疗和试验可用于 2 期和 3 期 T1D 的儿童。人群筛查项目的敏感性、特异性、阳性和阴性预测值仍有提高的空间；无论如何，关于在有患 T1D 风险的普通儿童人群中进行筛查计划的机会的争论非常激烈。本文由欧洲儿科内分泌学会 (ESPE) 认可，讨论了普通人群筛查计划的问题，希望通过更好的筛查方法、改进的成本/效益、可靠的方法来克服该领域的不确定性和困难儿童和青少年临床明显 T1D 的二级预防和相关延迟的治疗。人群筛查项目的敏感性、特异性、阳性和阴性预测值仍有提高的空间；无论如何，关于在有患 T1D 风险的普通儿童人群中进行筛查计划的机会的争论非常激烈。本文由欧洲儿科内分泌学会 (ESPE) 认可，讨论了普通人群筛查计划的问题，希望通过更好的筛查方法、改进的成本/效益、可靠的方法来克服该领域的不确定性和困难儿童和青少年临床明显 T1D 的二级预防和相关延迟的治疗。人群筛查项目的敏感性、特异性、阳性和阴性预测值仍有提高的空间；无论如何，关于在有患 T1D 风险的普通儿童人群中进行筛查计划的机会的争论非常激烈。本文由欧洲儿科内分泌学会 (ESPE) 认可，讨论了普通人群筛查计划的问题，希望通过更好的筛查方法、改进的成本/效益、可靠的方法来克服该领域的不确定性和困难儿童和青少年临床明显 T1D 的二级预防和相关延迟的治疗。关于在有患 T1D 风险的普通儿童人群中进行筛查计划的机会存在激烈的争论。本文由欧洲儿科内分泌学会 (ESPE) 认可，讨论了普通人群筛查计划的问题，希望通过更好的筛查方法、改进的成本/效益、可靠的方法来克服该领域的不确定性和困难儿童和青少年临床明显 T1D 的二级预防和相关延迟的治疗。关于在有患 T1D 风险的普通儿童人群中进行筛查计划的机会存在激烈的争论。本文由欧洲儿科内分泌学会 (ESPE) 认可，讨论了普通人群筛查计划的问题，希望通过更好的筛查方法、改进的成本/效益、可靠的方法来克服该领域的不确定性和困难儿童和青少年临床明显 T1D 的二级预防和相关延迟的治疗。