Project summary
It’s possible to identify people who are very likely to develop type 1 diabetes by looking for markers in the blood that show the immune system has begun attacking the pancreas. Professor Parth Narendran is exploring how a screening programme to test children for these early warning signs could best work in the UK.
The ELSA study will screen 20,000 children using a simple blood test. Screening could ensure children at high risk have the earliest, safest diagnosis possible and give families valuable time to prepare for life with type 1. It could also give children access to promising new treatments designed to delay the full development of type 1 diabetes. ELSA will provide vital insights on how to deliver screening at scale, paving the way for a routine, nationwide type 1 diabetes screening programme in the UK.
Background to research
Type 1 diabetes develops when the immune system destroys the cells in the pancreas that make insulin. We know that the immune system’s attack begins long before someone develops symptoms of type 1. It’s possible to spot early signs of this attack and identify people who have a high risk of developing type 1, or are already in its early, symptom-free stages.
Scientists do this by testing for markers in the blood called type 1 diabetes autoantibodies. Autoantibodies are used by the immune system to earmark insulin-making beta cells for destruction. They can appear months, years, or sometimes decades, before type 1 diabetes fully develops and someone is usually diagnosed.
Risk of type 1 diabetes increases with the number of different autoantibodies found. Once someone has two or more autoantibodies, it is almost certain they will develop type 1 diabetes in their lifetime. This is known as early-stage type 1 diabetes.
Excitingly, a new immunotherapy drug can delay the full onset of type 1 diabetes by around three years when given to people with early-stage type 1. But without a screening programme, we can't identify those who could benefit from it.
Research aims
Professor Parth Narendran will trial a UK-first programme to screen children for type 1 diabetes autoantibodies and find those likely to develop the condition, called the ELSA (EarLy Surveillance for Autoimmune diabetes) study. They will recruit 20,000 children, aged 3-13 years, across the UK. They’ll test for type 1 autoantibodies through a combination of finger stick and standard blood tests.
Depending on where they live, families can choose to have the finger prick blood test at home, at GP practices, schools, or alongside a regular childhood vaccination. The ELSA team will explore which of these screening approaches is most effective and practical, and check which work best for everyone, including families from different ethnicities and different economic backgrounds.
Children who are found to have autoantibodies and their families will be given education on type 1 symptoms to look out for, insulin injections, carb counting and hypos. This extra time to prepare can put families on the front foot, and remove some of the shock and distress at the time of diagnosis. Children will also be closely monitored to help make sure they start on insulin treatment as soon as they progress to full-blown type 1 diabetes, reducing the risk of dangerous diabetic ketoacidosis (DKA).
Children with autoantibodies could also be eligible to take part in immunotherapy clinical trials, testing treatments that hope to delay or prevent their type 1 diagnosis.
The ELSA team will speak to the families, healthcare professionals and school staff involved in the study to gather their views on the screening process. They’ll also interview families who decided not to take part, to understand the reasons why. This will help researchers decide how best to design any potential wider screening programme that could be rolled out through the NHS in the future.
Potential benefit to people with diabetes
The ELSA study will give us crucial insights that could help to make screening for type 1 diabetes a reality in the UK, and offer hope of a better future for children who are at high risk of the condition.
Identifying children at high risk of type 1 diabetes can help them to have a 'soft landing' into an eventual diagnosis, and dramatically reduce the risk of potentially life-threatening DKA.
Ultimately, screening could transform how we manage type 1 diabetes in the UK, moving us from waiting until diagnosis to treat it, to intervening earlier before too many beta cells have been destroyed. The first immunotherapy for type 1 diabetes, which has been shown to delay the condition, has been licensed in the UK. A type 1 diabetes autoantibody screening programme will be essential to make sure such treatments reach those who could benefit.
