New guidelines from France’s société francophone du diabète (SFD) are paving the way for expanded type 1 diabetes screening, especially for those with a family history of the disease. While type 1 diabetes accounts for roughly 5-10% of all diabetes cases, affecting an estimated 25,000 children and adolescents in france, proactive screening could significantly improve outcomes by enabling earlier intervention and potentially delaying disease progression. The initiative, building on prosperous models in Germany and Italy, aims too identify individuals at risk before experiencing severe symptoms, offering a new approach to managing this autoimmune condition.
Individuals with a family history of type 1 diabetes may soon have access to expanded screening options, offering the potential for earlier diagnosis and intervention. While type 2 diabetes is largely linked to lifestyle factors, type 1 diabetes – which often develops in younger individuals – has a strong genetic component and is an autoimmune condition that progressively destroys insulin-producing cells in the pancreas.
The risk of developing type 1 diabetes is relatively low at 0.4% for those without a family history, but increases significantly to 4% if a sibling, brother, or mother has the condition, and even further to 8% if a father is affected. These statistics have prompted a push for proactive screening among first-degree relatives of people living with type 1 diabetes.
New Care Pathways
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In September 2024, the Société francophone du diabète (SFD) issued recommendations advocating for screening for individuals aged 2 to 45 who have a parent, sibling, or child with type 1 diabetes. Based on the approximately 25,000 children and adolescents with type 1 diabetes in France, Dr. Rachel Reynaud, head of the multidisciplinary pediatric department at Timone Hospital in Marseille, estimates that around 66,000 people would be eligible for screening, as presented at the SFD’s annual congress in Paris in early April.
While some centers in Paris, Lyon, and Marseille are already offering screening, implementation is expected to be gradual across the country. “These are new care pathways that need to be built, which takes time,” explained Dr. Jacques Beltrand of the pediatric endocrinology, gynecology, and diabetology department at Necker-Enfants Malades Hospital in Paris. “There’s no absolute urgency to rush, but it’s essential to do it right.” A clinical trial, planned to launch in late 2024 or early 2026, will help refine these care pathways, potentially including at-home testing using a simple blood sample.
Germany and Italy Leading the Way
Several countries are ahead of France in implementing widespread screening programs. A study conducted in Bavaria, Germany, demonstrated the effectiveness of screening for type 1 diabetes in children within the general population, regardless of family history. Italy is a pioneer in this area, with nationwide screening already underway.
“Rather than launching a large-scale program immediately, we felt it was preferable to start with a high-risk population to raise awareness among medical teams and funding bodies, and to build the necessary care pathways,” said Jacques Beltrand. “The goal, within three, five, or ten years, is to offer this screening to the general population.”
Preventing Complications and Delaying Progression
Early detection of type 1 diabetes is crucial for preventing serious health complications. Experts at the SFD emphasize the importance of screening to prevent diabetic ketoacidosis, prolonged hospitalizations, rapid decline in residual insulin secretion, and an increased risk of long-term complications. According to Santé publique France, 97 children aged 1 to 14 died from type 1 diabetes between 1987 and 2016, with 58% of those deaths attributed to ketoacidosis – a figure that rises to 70% in children aged 1 to 4. The aim is to diagnose the disease before it reaches a critical stage (stage 3), ideally at stage 1 – the presence of at least two diabetes-specific autoantibodies – or stage 2 – the presence of dysglycemia.
Gestational Diabetes: A Long-Term Risk for Mother and Child
Other forms of diabetes also have implications for family health. Gestational diabetes, for example, increases the risk of overweight and obesity in children. However, many pediatricians are unaware of their young patients’ history of maternal gestational diabetes. Fortunately, the updated health record book, in effect since January 2025, now allows for the documentation of parental diabetes history, without specifying the type.
Mothers who have experienced gestational diabetes face a tenfold increased risk of developing type 2 diabetes later in life. In 2010, the French College of Gynecologists and Obstetricians (CNGOF) and the SFD recommended screening for type 2 diabetes during the postpartum consultation and before any future pregnancies, as well as regular screening every one to three years for up to 25 years, depending on risk factors.
Maintaining Vigilance
In practice, this follow-up is often lacking, according to Dr. Anne Vambergue, head of the diabetology and nutrition department at the Lille University Hospital Center. “During pregnancy, these mothers are highly motivated, but once they return to their daily lives, they tend to forget about it,” she explains. “However, they need to be aware of this high risk, get screened regularly, and continue to follow the dietary and lifestyle recommendations given during pregnancy.” According to Anne Vambergue, “preventing diabetes in the mother by encouraging a healthier diet and physical activity also reduces the risk of overweight and obesity in her child – a benefit for the whole family.”
Teplizumab Shows Promise
Beyond preventing complications, early detection may also offer therapeutic benefits. Research is underway to identify treatments that can delay or even prevent the progression to stage 3 in patients at a pre-clinical stage. Currently, only one treatment, teplizumab – a humanized anti-CD3 monoclonal antibody – has shown promise. Clinical trials have demonstrated that teplizumab can delay the onset of stage 3 by two years in patients treated at stage 2.
Approved in the United States in 2022, this biologic therapy, administered as a two-week course, does not yet have marketing authorization in the European Union but is available in France through compassionate use programs. Since April 2024, approximately ten young diabetic patients (aged 13 to 18) diagnosed at stage 2 have received teplizumab treatment in France. Among the four patients followed at Necker Hospital, none have progressed to stage 3.
Promising Results with Verapamil
Other treatments, already approved for different indications, are also being evaluated. These include immunomodulatory biologics and strategies to protect pancreatic beta cells from autoimmune attacks. Verapamil, an oral antiarrhythmic drug, has shown promising results in preserving insulin secretion in recently diagnosed patients. According to Jacques Beltrand, “we may be moving towards combination therapies, similar to cancer treatment. This will require clinical trials, obviously international, as patients detected at stages 1 and 2 remain rare. France needs to position itself in this research to acquire expertise in immunotherapy.”
Ethical Considerations Emerge
While early screening for type 1 diabetes opens new therapeutic avenues, it also raises ethical questions, particularly regarding assigning the status of “patient” to children without clinical symptoms. According to Jacques Beltrand, these patients “are already ill, but at a pre-clinical stage without being aware of it, which can be very difficult for a child to cope with. Teams must be able to support families, explain the process, and help them gradually adjust to the disease.”
The progression to stage 3 is gradual: “The patient will start with blood glucose tests, then will need slow-acting insulin injections, followed by rapid-acting insulin. This requires regular contact with the care team to learn these medical procedures,” explains the Parisian diabetologist. Psychological support may also be necessary in some cases: “We offer it systematically. Not everyone needs it, but what they express in consultation can help us improve our practice.”
Key Takeaways
- Individuals related to a person with type 1 diabetes have a 10 to 20 times higher risk of developing the condition themselves.
- Early screening is being implemented within these families to identify patients at a pre-clinical stage. It may eventually be extended to the general population.
- Beyond preventing complications of type 1 diabetes, treatments aimed at delaying or preventing the onset of clinical disease are being evaluated. Teplizumab, an anti-CD3 antibody, is currently available through compassionate use programs.
