Gastric Cancer

# Gastric Cancer *Published: 2026 May 21* print. Screening Children for Early-Stage Type 1 Diabetes. Winkler C(1)(2), Friedl N(1), Abt R(3), Ackermann K(1), Bently J(4), Braig S(5), Brämswig S(6), Dunstheimer D(7), Ermer U(8), Ewald D(9), Gerstl EM(10), Hammersen J(11), Haupt F(1)(2), Hergl M(1), Hubmann M(12)(13), Hummel S(1)(2)(14), Jochem B(15), Knopff A(1), Lange K(16), Lwowsky D(3), Nellen-Hellmuth N(17), Prey B(18), Rettner D(19), Schill S(1)(14), Schmidt S(20), Scholz M(1), Sindichakis M(21), Stock J(1), Stricker D(15), Völkl TMK(22), Warncke K(23)(24), Weber L(25), Weiss A(1), Bonifacio E(2)(26)(27), Achenbach P(1)(2)(14), Ziegler AG(1)(2)(14). Author information: (1)Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany. (2)German Center for Diabetes Research (DZD), Munich, Germany. (3)Kinder- und Jugendärzte Wendelstein, Wendelstein, Germany. (4)Nuremberg Hospital South, Nuremberg, Germany. (5)Pediatric Clinic of the Bayreuth Hospital, Bayreuth, Germany. (6)RoMed Hospital, Rosenheim, Germany. (7)Department of Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany. (8)St Elisabeth Klinik, Neuburg/Donau, Germany. (9)Gemeinschaftspraxis für Kinder- und Jugendmedizin, Regensburg, Germany. (10)Children's Hospital Dritter Orden, Passau, Germany. (11)University Hospital, Department of Pediatrics, Erlangen, Germany. (12)Kinderärzte Zirndorf, Praxis für Kinder- und Jugendmedizin, Zirndorf, Germany. (13)German Association of Paediatric and Adolescent Care Specialists (BVKJ), Cologne, Germany. (14)Technical University of Munich, School of Medicine and Health, Forschergruppe Diabetes at Klinikum rechts der Isar, TUM University Hospital, Munich, Germany. (15)Kinderarztpraxis, Lappersdorf, Germany. (16)Hannover Medical School, Department of Medical Psychology, Hannover, Germany. (17)MVZ and Hospital Leopoldina, Schweinfurt, Germany. (18)Hospital Amberg, Germany. (19)Hospital Leopoldina, Schweinfurt, Germany. (20)Children´s Hospital, Klinikum Dritter Orden, Munich, Germany. (21)Hospital Traunstein, Traunstein, Germany. (22)Department of Pediatrics and Adolescent Medicine, KJF Klinik Josefinum, Augsburg, Germany. (23)Technical University of Munich, Germany, TUM School of Medicine and Health, Department of Pediatrics, Munich, Germany. (24)German Center for Child and Adolescent Health (DZKJ), Munich, Germany. (25)Hospital Kempten, Kempten, Germany. (26)Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. (27)Paul Langerhans Institute Dresden of the Helmholtz Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany. Comment in doi: 10.1001/jama.2026.0561. doi: 10.1001/jama.2026.0048. Comment in doi: 10.1001/jama.2026.6454. ## IMPORTANCE Detecting type 1 diabetes in presymptomatic stages is essential for therapies aimed at delaying clinical onset. ## OBJECTIVE To estimate early-stage (stage 1 or 2) type 1 diabetes prevalence and disease progression to clinical (stage 3) type 1 diabetes in children in a population-based screening study. DESIGN, SETTING, AND PARTICIPANTS From February 2015 to July 2025, children living in Bavaria, Germany, were screened for early-stage type 1 diabetes. Screening was conducted by 716 primary care pediatricians. Screening was performed once in children aged 1.75 to 5.99 years until March 2019 and was subsequently expanded to include up to 2 screenings in children aged 1.75 to 10.99 years. Families of children with early-stage disease were offered diabetes education, metabolic staging, and longitudinal monitoring in 18 specialized diabetes centers. ## EXPOSURES Measurement of islet autoantibodies. MAIN OUTCOMES AND MEASURES The primary outcome was early-stage type 1 diabetes, defined as 2 or more autoantibodies against insulin, glutamic acid decarboxylase, islet antigen-2, or zinc transporter 8 confirmed in consecutive blood samples, with categorization into stages 1 (normoglycemia) and 2 (dysglycemia) and progression to clinical (stage 3) diabetes. ## RESULTS Among 220 476 enrolled children (median [IQR] age, 3.1 [2.2-5.0] years; 106 952 [48.7%] females), 590 had presymptomatic early-stage type 1 diabetes at first screening (adjusted population frequency, 0.3% [95% CI, 0.28%-0.32%]) with prevalences of 0.23% for stage 1 and 0.06% for stage 2 type 1 diabetes. Repeat screening in 11 726 children after a median of 3.3 years identified 29 additional cases. During a median follow-up of 5.7 years, 212 children with an early-stage diagnosis at first screening, 5 with a diagnosis at rescreening, and 43 without an early-stage diagnosis developed clinical (stage 3) diabetes. Five-year progression from early-stage to clinical diabetes was 36.2% (95% CI, 31.2%-40.8%; annualized rate, 9.6%), and not significantly different between children with and without a first-degree family history (P = .54). CONCLUSIONS AND RELEVANCE General population screening of children identified early-stage type 1 diabetes and similar progression rates to clinical diabetes between children with and without a first-degree family history. These findings inform disease-modifying therapy trials and suggest that screening can be considered beyond genetically selected populations. ## TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04039945. DOI: 10.1001/jama.2026.6085 PMCID: PMC13195511 DOI: 10.1001/jama.2026.3754