Screening for diabetes mellitus type 1 in the pediatric general population: an ethical analysis

TL;DR

This paper examines the ethical issues of screening children for type 1 diabetes using autoantibodies, highlighting the need to balance early detection benefits with potential risks and resource challenges.

Contribution

The study offers a novel ethical analysis of type 1 diabetes screening using Beauchamp and Childress’s four principles, identifying key ethical domains for future research and implementation.

Findings

Key ethical concerns include decision-making for children, psychological impact, and resource allocation.

Screening raises risks like psychological distress and stigmatization that must be weighed against early detection benefits.

Future research should address screening feasibility, optimal timing, and preventive treatment options like teplizumab.

Abstract

Autoantibodies can predict clinical type 1 diabetes, impacting early diagnosis, prevention, and management. While integrating antibody testing into routine practice is debated globally, ethical considerations are often overlooked. This paper explores these ethical concerns through qualitative analysis based on a literature review. A PubMed literature search provided the foundation for a qualitative ethical analysis. Arguments regarding type 1 diabetes screening were extracted from 92 eligible articles and categorized using Beauchamp and Childress’s four ethical principles. A thematic and principle-oriented ethical analysis was conducted. Key ethical concerns include decision-making for children, risk determination, screening timepoints, psychological aspects, DKA rates, treatment options, and monetary and personnel aspects. Addressing these issues ensures general population screening aligns with autonomy, beneficence, nonmaleficence, and justice.

Conclusions; General population antibody screening for type 1 diabetes presents ethical challenges requiring careful consideration. While early detection offers benefits, risks such as psychological distress, stigmatization, and resource diversion must be taken into consideration. Further research should assess feasibility, including human resource demands, parental and child anxiety, optimal screening timepoints, development of educational material, children’s involvement in screening, and expanding options for prevention, including teplizumab approval in the EU.
What is Known:• Autoantibodies can identify individuals at risk for Type 1 Diabetes before symptom onset, and population screening is increasingly discussed as a strategy to reduce complications such as diabetic ketoacidosis at diagnosis.What is New:• This study provides a structured ethical analysis of general population antibody screening for Type 1 Diabetes using the four-principle framework of Beauchamp and Childress (autonomy, beneficence, nonmaleficence, justice)• It identifies key ethical domains, including decision-making for children, psychological impact, screening timing, resource allocation, and emerging preventive options such as Teplizumab, that should guide future implementation and research on population screening programs

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