Author: Aimee Richter
Type 1 diabetes is a lifelong autoimmune condition where the body mistakenly attacks the insulin producing cells of the pancreas and therefore the ability to regulate sugar. Type 1 diabetes is not reversable and requires lifelong insulin injections.
As many as 20% of the 175,000 global deaths are in people not yet diagnosed and so could be preventable with early detection before symptoms occur.
The goal of the ELSA study is to identify individuals with type 1 diabetes earlier, educate them about the risk and identify those that might be suitable for a new treatment which slows the onset of diabetes. The ELSA study is being run by the University of Birmingham and led by Professor Parth Narendran. The ELSA study is co-funded by Diabetes UK and JDRF.
ELSA screens children aged 3-13 across all UK regions with a finger-prick blood test to identify antibody markers which occur in the blood before type 1 diabetes symptoms occur and insulin is needed.
What does the study involve?
Children are invited to undertake a finger-prick blood test which can be done either in a community setting or at home.
The sample gets returned to the laboratory in the routine post and tested for the presence of type 1 diabetes antibodies.
For any child that is found to be positive for antibodies, they get offered a blood test to confirm the result and work out how many antibodies they are positive to as this determines the risk of the type 1 diabetes progressing.
If children are positive they and their parents are provided with an education session about type 1 diabetes
To find out whether screening for type 1 diabetes is acceptable and feasible the study also interviews with parents/ guardians and health care professionals to provide feedback on the screening programme
What is being tested for?
The study is testing for antibodies, which are proteins the immune system makes. If these are found in a child’s blood, it suggests their immune system is attacking the insulin-producing cells in the pancreas, increasing the risk of developing type 1 diabetes.
There are 4 key antibodies that the ELSA study is testing for.
The number of antibodies a child has increases their risk of developing type 1 diabetes in the future.
For children who have 1 of these antibodies present, their risk is not as high, but they could develop more antibodies over time and their risk will increase.
For children who don’t have any of these antibodies, they have a very low chance of developing type 1 diabetes.
3/1000 children are at high risk of having type 1 diabetes, and we can only find these children by screening them.
Understanding the Antibody Count
The ELSA study tests for four specific protein markers (autoantibodies): GAD, IA-2A, ZnT8, and IAA. These are essentially warnings to the immune system that they are attacking the insulin-producing cells in the pancreas. The different amount of of antibodies present describe the risk of the patient developing type 1 diabetes.
Why Early Detection is important
While the goal is to find diabetes early, the primary benefit is preventing Diabetic Ketoacidosis (DKA).
Preventing Emergencies: About 25-30% of children diagnosed with Type 1 diabetes are only found when they are already in DKA, a life-threatening emergency. Screening can reduce this risk to near zero.
The “Softer Landing”: Families who know their child is at risk can be educated on the “4 Ts” (Thirst, Toilet, Tiredness, Thinner). This allows them to start insulin in a calm, controlled way at home rather than in an ICU.
Preserving Beta Cells: Early diagnosis is linked to better long-term blood sugar control, which protects the heart, eyes, and kidneys later in life.
Access to treatments
The ELSA study isn’t just about identifying what children have diabetes but also giving them treatment.
Teplizumab: This groundbreaking drug, recently licensed in the UK for individuals aged 8 and up, acts as a lab-made shield (known scientifically as a monoclonal antibody). It can delay the onset of Type 1 diabetes by an average of 3 years.
Research Trials: Children identified as high-risk through ELSA may be eligible for clinical trials testing other new treatments that aim to “retrain” the immune system and stop the attack on the pancreas altogether.
Real-life stories
A young patient identified by the ELSA study as having early stages of Type 1 Diabetes has received treatment to delay the condition.
Sam, aged 14 and from Kings Norton, was the first to receive the new drug, Teplizumab, at the Clinical Research Facility at Birmingham Children’s Hospital.
Sam’s dad, Chris, has type 1 diabetes and knowing that family members are more likely to develop the disease, Sam was screened for early stages of the condition and learnt he would develop type 1 diabetes. However, the patient was given Teplizumab, a new treatment to delay the onset of the chronic illness. Past trials have proven that Teplizumab delays insulin-dependent diabetes for up to three years. that Teplizumab delays insulin-dependent diabetes for up to three years. Teplizumab is a monoclonal antibody which acts as a shield that sits between the immune system’s T-cells and the pancreas’s beta cells, slowing down the destruction.
