# Is the Current Screening Availability for Early Stages of Type 1 Diabetes in Germany Related to the Population‐Based Frequency of Diabetic Ketoacidosis at Clinical Manifestation in Children and Adolescents

## TL;DR

This study examines if diabetes screening in Germany is linked to fewer cases of severe diabetes at diagnosis in children.

## Contribution

The study evaluates the population-level impact of regional screening initiatives on diabetic ketoacidosis rates in children with type 1 diabetes.

## Key findings

- Screening availability was not associated with lower DKA rates overall.
- Younger children (under 3 years) had an 83% higher risk of DKA at diagnosis.
- Higher screening coverage in Bavaria showed a potential benefit in reducing DKA.

## Abstract

Is the current screening for early‐stage type 1 diabetes (T1D) associated with the rate of diabetic ketoacidosis (DKA) at T1D manifestation at population level?

Children with T1D manifestation in 2015–2023 in Germany, aged 0.5 to <15 years from the multicenter diabetes registry (DPV) were included and allocated to federal states (FSs) based on their residential postal code. The relative risk (RR) with 95% confidence interval for DKA at manifestation of T1D by FS with vs. without screening, and demographic/context factors was calculated using logistic regression models.

24,408 children (54.3% males) were included with median onset age of 8.8 (quartiles: 5.3; 11.8) years. The RR for DKA was not significantly lower in FS with vs. without screening (RR: 0.96 [0.93–1.03], p = 0.393) overall, but in the sub‐group of children with the highest probability of being screened (age 1.75–10.99 years, manifestation in Bavaria from 2020 to 2023, RR: 0.88 [0.80–0.97], p = 0.012). The most important predictor for DKA was manifestation age <3 years (RR: 1.83, [1.66–2.03], p < 0.001).

Until 2023, current regional screening initiatives for early‐stage T1D were not associated with lower frequency of DKA at population level, but might be helpful in the future if the coverage can be markedly increased.