Childhood diabetes crisis stalks Europe, more screening urged

The International Diabetes Federation (IDF) predicts a 13% rise in diabetes prevalence in Europe by 2045, with 61 million affected. Europe has the highest incidence of Type 1 diabetes (T1D) in children and adolescents, and the second highest per-person diabetes cost globally, spending €175 billion in 2021.

In terms of global regions, Europe now reports the highest number of children and adolescents with T1D, with approximately 295,000 cases.

Grace O’Sullivan, MEP (Greens-EFA), said: “Ireland in particular, has an issue with diabetes in children. We are in the top 25% of diabetes incidence worldwide and the numbers are going in the wrong direction.”

“Early screening efforts need to be stepped up, as now most diagnoses are made on an ad hoc basis and for very young children the signs can be difficult to spot.”

Patients… and families…

Diabetes is not always preventable and not always caused by environmental influences – genetics and the body’s auto-immune responses can be the driving determinants.

Joanne Murphy, Professor of Inclusive Leadership Birmingham Business School, University of Birmingham told Euractiv: “Our daughter was diagnosed when she was six. Since then, T1D has been a constant and unwelcome companion. It hangs on, 24 hours a day, seven days a week. There is no break, no holiday, only the relentless reality of managing the function of a bodily organ – with little information and terrible consequences if you get it wrong.”

“Sometimes, just when you think you know what you’re doing, it rears like a sleeping deadly dragon. Hopefully, someday it will be gone through the incredibly work of researchers and activists, but until then we go on, hoping we can stay one step ahead.”

New research, better screening

Chantal Mathieu, current President of the European Association of the Study of Diabetes (EASD), explained that tools exist to screen for the presence of autoantibodies against the beta-cell – the insulin-producing cell – in the blood of people with very un-invasive methods, like a finger-prick. The presence of these antibodies shows early stages of T1D and predicts progression to the clinical stage of the disease.

“Throughout Europe, screening campaigns in first degree relatives of people with T1D, like Fr1da and INNODIA are running,” said Mathieu, “and even screening of the general population is now happening, like in EDENT1FI.” But, she said, more is needed.

She described how some countries, like Italy, have mandated screening for Type 1 diabetes into law, adding that she believes it’s time to screen all for early-stage T1D. In doing so, potentially life-threatening diabetic ketoacidosis, at presentation of the clinical disease, can be avoided in most patients.

In Germany, the Fr1da project, launched in Bavaria, is a large-scale screening initiative for early detection of T1D in children. The Fr1da study is the first population-based approach for the early diagnosis T1D associated autoimmunity in childhood.

The project aims to provide optimal treatment and improve disease understanding, with over 200 paediatric practices participating across Bavaria.

EU supporting diabetes research and education

While healthcare policies are primarily the responsibility of EU Member States, the European Commission addresses diabetes within its work on non-communicable diseases (NCDs), supporting Member States in achieving UN and WHO targets on NCDs by 2025.

It also supports research in this area under Horizon 2020, with a broad scope aiming to translate new knowledge into innovative applications and accelerate large-scale uptake. One programme is the Healthier Together initiative (2022-2027) which aims to reduce the burden of NCDs, including diabetes.

The European Parliament (EP) has passed a significant resolution on “prevention, management, and better care of diabetes in the EU.” Article 7 of the EP’s World Diabetes Day resolution of 23 November 2022 calls on Member States “to develop, implement and monitor national diabetes plans and strategies with comparable milestones and targets, including a risk-reduction and screening/early action component…”.

In addition, the EU’s Innovative Health Initiative (IHI), for example, has allocated €23 million to the EDENT1F1 project. Launched in late 2023, the initiative aims to promote universal screening for non-clinical T1D, particularly among children, across 12 countries.

Diabetes election manifestos

Building on this substantial structure and seeking to engage Europe’s politicians in the runup to election season, the European Diabetes Forum (EUDF) has launched an Election Pledge aimed at drawing support from Europe’s political groups.

The Pledge invites candidates to demonstrate their support for the 32 million people living with diabetes in the EU, and their families. It focuses on early detection, equitable care, empowering people through education, as well as embracing science and technology, and highlights potential cost savings of €104 billion – estimated at 75% of costs derived from avoidable complications.

With the European elections set for June, Europe’s political groups will soon launch their manifestos, each with specific health agendas, EUDF aims to communicate the importance of diabetes as a critical health and economic issue.

“On message”

Carine de Beaufort, former President of the International Society for Pediatric and Adolescent Diabetes (ISPAD) said manifestos should focus on children and prevention, she told Euractiv “We still see a high number of children with newly onset diabetes, where early signs and symptoms have been missed.”

She added that many of the children have actually seen a doctor in the two weeks before hospitalisation, and that this severe onset which specialists still seeing, has a long-lasting impact. “Prevention might be possible with a carefully planned and accompanied screening program,” remarked de Beaufort.

Asked by Euractiv what his message to citizens will be in terms of managing diabetes and early detection, Renew MEP, Billy Kelleher said: “Governments must invest more in awareness and early detection campaigns. Diabetes is something we can reduce a lot in society if the right programmes and supports are put in place early on in peoples’ lives.”

MEP Grace O’Sullivan said Europe’s political parties must understand that screening and quality of care should be urgent and universal. She explained: “…we need to address the inherent inequalities of our health system – your economic background should not determine the quality of care and screening you get.”

[By Brian Maguire | Euractiv’s Advocacy Lab ]

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