1型糖尿病早期筛查的研究进展与优化策略

宋启君; 孙妍

doi:10.7499/j.issn.1008-8830.2505123

PDF(766 KB)

HTML

中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (11) : 1310-1316. DOI: 10.7499/j.issn.1008-8830.2505123

系列述评——生长障碍疾病诊疗

1型糖尿病早期筛查的研究进展与优化策略

宋启君 (综述) ,
孙妍 (审校)

作者信息 +

Research progress and optimization strategies for early screening of type 1 diabetes

Qi-Jun SONG ,
Yan SUN

Author information +

文章历史 +

摘要

1型糖尿病（type 1 diabetes, T1DM）患病率逐年升高，并发症严重危害患儿生活质量。早期筛查T1DM有助于减少酮症酸中毒的发生，保护β细胞功能，延缓高危人群发病，具有重要意义。该文汇总了目前T1DM的国内外主要筛查技术，筛查手段仍以糖尿病相关抗体检测和糖代谢指标为核心，发病机制相关因素有望成为敏感性筛查指标。期待在我国推广T1DM筛查，不断提高T1DM的早诊早治水平。

Abstract

The prevalence of type 1 diabetes (T1DM) is increasing annually, and its complications seriously impair the quality of life of affected children. Early screening for T1DM helps reduce the occurrence of diabetic ketoacidosis, protect β-cell function, and delay disease onset in high-risk populations. This article summarizes current domestic and international screening technologies for T1DM. Screening methods remain centered on detection of diabetes-related antibodies and glycometabolic markers, while factors related to disease pathogenesis hold promise as sensitive screening markers. Expanding T1DM screening in China is expected to improve early diagnosis and treatment.

导出引用

宋启君, 孙妍. 1型糖尿病早期筛查的研究进展与优化策略[J]. 中国当代儿科杂志. 2025, 27(11): 1310-1316 https://doi.org/10.7499/j.issn.1008-8830.2505123

Qi-Jun SONG, Yan SUN. Research progress and optimization strategies for early screening of type 1 diabetes[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(11): 1310-1316 https://doi.org/10.7499/j.issn.1008-8830.2505123

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	中华医学会糖尿病学分会, 中国医师协会内分泌代谢科医师分会, 中华医学会内分泌学分会, 等. 中国1型糖尿病诊治指南（2021版）[J]. 中华糖尿病杂志, 2022, 14(11): 1143-1250. DOI: 10.3760/cma.j.cn115791-20220916-00474 . 本文引用 [2]

[2]

Gregory

, Robinson

TIG

, Linklater

, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study[J]. Lancet Diabetes Endocrinol, 2022, 10(10): 741-760. DOI: 10.1016/S2213-8587(22)00218-2 .

https://www.ncbi.nlm.nih.gov/pubmed/36113507

本文引用 [1]

[3]	Gomez P, Sanchez J. Type 1 diabetes screening and diagnosis[J]. Endocrinol Metab Clin North Am, 2024, 53(1): 17-26. DOI: 10.1016/j.ecl.2023.09.008 . https://www.ncbi.nlm.nih.gov/pubmed/38272595 本文引用 [1]

[4]	Moore DJ, Leibel NI, Polonsky W, et al. Recommendations for screening and monitoring the stages of type 1 diabetes in the immune therapy era[J]. Int J Gen Med, 2024, 17: 3003-3014. PMCID: PMC11247126. DOI: 10.2147/IJGM.S438009 . https://www.ncbi.nlm.nih.gov/pubmed/39011423 本文引用 [3]

[5]

Haller

, Bell

, Besser

REJ

, et al. ISPAD clinical practice consensus guidelines 2024: screening, staging, and strategies to preserve beta-cell function in children and adolescents with type 1 diabetes[J]. Horm Res Paediatr, 2024, 97(6): 529-545. PMCID: PMC11854978. DOI: 10.1159/000543035 .

https://www.ncbi.nlm.nih.gov/pubmed/39662065

本文引用 [8]

[6]

Liu

, Yuan

, Guo

, et al. Incidence of type 1 diabetes may be underestimated in the Chinese population: evidence from 21.7 million people between 2007 and 2017[J]. Diabetes Care, 2021, 44(11): 2503-2509. PMCID: PMC8546282. DOI: 10.2337/dc21-0342 .

https://www.ncbi.nlm.nih.gov/pubmed/34413068

本文引用 [1]

[7]	Food and Drug Administration. FDA approves first drug that can delay onset of type 1 diabetes[EB/OL]. (2023-01-01)[2025-04-23]. https://www.fda.gov/media/164864/download 本文引用 [1]

[8]	Herold KC, Bundy BN, Long SA, et al. An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes[J]. N Engl J Med, 2019, 381(7): 603-613. PMCID: PMC6776880. DOI: 10.1056/NEJMoa1902226 . https://www.ncbi.nlm.nih.gov/pubmed/31180194 本文引用 [1]

[9]	Tatovic D, Narendran P, Dayan CM. A perspective on treating type 1 diabetes mellitus before insulin is needed[J]. Nat Rev Endocrinol, 2023, 19(6): 361-370. DOI: 10.1038/s41574-023-00816-5 . https://www.ncbi.nlm.nih.gov/pubmed/36914759 本文引用 [1]

[10]	Sims EK, Besser REJ, Dayan C, et al. Screening for type 1 diabetes in the general population: a status report and perspective[J]. Diabetes, 2022, 71(4): 610-623. PMCID: PMC9114719. DOI: 10.2337/dbi20-0054 . https://www.ncbi.nlm.nih.gov/pubmed/35316839 本文引用 [1]

[11]	孙肖霄, 黄干, 谢志国, 等. 1型糖尿病遗传学研究进展[J]. 中华医学杂志, 2020, 100(10): 793-796. DOI: 10.3760/cma.j.cn112137-20190621-01394 . 本文引用 [5]

[12]	Herold KC, Delong T, Perdigoto AL, et al. The immunology of type 1 diabetes[J]. Nat Rev Immunol, 2024, 24(6): 435-451. PMCID: PMC7616056. DOI: 10.1038/s41577-023-00985-4 . https://www.ncbi.nlm.nih.gov/pubmed/38308004 本文引用 [7]

[13]	Du M, Li S, Jiang J, et al. Advances in the pathogenesis and treatment strategies for type 1 diabetes mellitus[J]. Int Immunopharmacol, 2025, 148: 114185. DOI: 10.1016/j.intimp.2025.114185 . https://www.ncbi.nlm.nih.gov/pubmed/39893858 本文引用 [1]

[14]	Buschard K. The etiology and pathogenesis of type 1 diabetes: a personal, non-systematic review of possible causes, and interventions[J]. Front Endocrinol (Lausanne), 2022, 13: 876470. PMCID: PMC9452747. DOI: 10.3389/fendo.2022.876470 . https://www.ncbi.nlm.nih.gov/pubmed/36093076 本文引用 [5]

[15]	Carré A, Vecchio F, Flodström-Tullberg M, et al. Coxsackievirus and type 1 diabetes: diabetogenic mechanisms and implications for prevention[J]. Endocr Rev, 2023, 44(4): 737-751. DOI: 10.1210/endrev/bnad007 . https://www.ncbi.nlm.nih.gov/pubmed/36884282 本文引用 [1]

[16]	Quattrin T, Haller MJ, Steck AK, et al. Golimumab and beta-cell function in youth with new-onset type 1 diabetes[J]. N Engl J Med, 2020, 383(21): 2007-2017. DOI: 10.1056/NEJMoa2006136 . https://www.ncbi.nlm.nih.gov/pubmed/33207093 本文引用 [1]

[17]

Lledó-Delgado

, Preston-Hurlburt

, Currie

, et al. Teplizumab induces persistent changes in the antigen-specific repertoire in individuals at risk for type 1 diabetes[J]. J Clin Invest, 2024, 134(18): e177492. PMCID: PMC11405034. DOI: 10.1172/JCI177492 .

https://www.ncbi.nlm.nih.gov/pubmed/39137044

本文引用 [1]

[18]	Atkinson MA, Mirmira RG. The pathogenic "symphony" in type 1 diabetes: a disorder of the immune system, β cells, and exocrine pancreas[J]. Cell Metab, 2023, 35(9): 1500-1518. PMCID: PMC10529265. DOI: 10.1016/j.cmet.2023.06.018 . https://www.ncbi.nlm.nih.gov/pubmed/37478842 本文引用 [2]

[19]	Phillip M, Achenbach P, Addala A, et al. Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes[J]. Diabetes Care, 2024, 47(8): 1276-1298. PMCID: PMC11381572. DOI: 10.2337/dci24-0042 . https://www.ncbi.nlm.nih.gov/pubmed/38912694 本文引用 [3]

[20]	中华医学会糖尿病学分会, 中华医学会儿科学分会, 中华医学会内分泌学分会, 等. 中国1型糖尿病高危人群筛查、监测与管理专家共识（2024版）[J]. 中华糖尿病杂志, 2024, 16(11): 1183-1199. DOI: 10.3760/cma.j.cn115791-20241001-00592 . 本文引用 [6]

[21]	March CA, Becker DJ, Libman IM. Nutrition and obesity in the pathogenesis of youth-onset type 1 diabetes and its complications[J]. Front Endocrinol (Lausanne), 2021, 12: 622901. PMCID: PMC8021094. DOI: 10.3389/fendo.2021.622901 . https://www.ncbi.nlm.nih.gov/pubmed/33828529 本文引用 [2]

[22]	Fu Y, Zhang C, Gu Y, et al. Establishing reference intervals for islet autoantibodies in Han Chinese type 1 diabetes[J]. Scand J Clin Lab Invest, 2021, 81(8): 641-648. DOI: 10.1080/00365513.2021.2001564 . https://www.ncbi.nlm.nih.gov/pubmed/34779329 本文引用 [1]

[23]	Vehik K, Bonifacio E, Lernmark Å, et al. Hierarchical order of distinct autoantibody spreading and progression to type 1 diabetes in the TEDDY study[J]. Diabetes Care, 2020, 43(9): 2066-2073. PMCID: PMC7440899. DOI: 10.2337/dc19-2547 . https://www.ncbi.nlm.nih.gov/pubmed/32641373 本文引用 [1]

[24]	Brenu EW, Harris M, Hamilton-Williams EE. Circulating biomarkers during progression to type 1 diabetes: a systematic review[J]. Front Endocrinol (Lausanne), 2023, 14: 1117076. PMCID: PMC9935596. DOI: 10.3389/fendo.2023.1117076 . https://www.ncbi.nlm.nih.gov/pubmed/36817583 本文引用 [1]

[25]	Zhong T, Li X, Lei K, et al. CXCL12-CXCR4 mediates CD57⁺ CD8⁺ T cell responses in the progression of type 1 diabetes[J]. J Autoimmun, 2024, 143: 103171. DOI: 10.1016/j.jaut.2024.103171 . https://www.ncbi.nlm.nih.gov/pubmed/38306953 本文引用 [1]

[26]	Schroderus AM, Pitkänen V, Ekman I, et al. Temporal alterations in CD8⁺ T cells during the progression from stage 1 to stage 3 type 1 diabetes[J]. Diabetes, 2024, 73(10): 1705-1715. DOI: 10.2337/db24-0159 . https://www.ncbi.nlm.nih.gov/pubmed/38967999 本文引用 [1]

[27]

Barcenilla

, Åkerman

, Pihl

, et al. Mass cytometry identifies distinct subsets of regulatory T cells and natural killer cells associated with high risk for type 1 diabetes[J]. Front Immunol, 2019, 10: 982. PMCID: PMC6509181. DOI: 10.3389/fimmu.2019.00982 .

https://www.ncbi.nlm.nih.gov/pubmed/31130961

本文引用 [1]

[28]

Harms

, Lorenzo-Arteaga

, Ostlund

, et al. Abnormal T cell frequencies, including cytomegalovirus-associated expansions, distinguish seroconverted subjects at risk for type 1 diabetes[J]. Front Immunol, 2018, 9: 2332. PMCID: PMC6204396. DOI: 10.3389/fimmu.2018.02332 .

https://www.ncbi.nlm.nih.gov/pubmed/30405601

本文引用 [1]

[29]	Ferreira-Hermosillo A, Santana-Sánchez P, Vaquero-García R, et al. Circulating T cell subsets in type 1 diabetes[J]. Cells, 2025, 14(1): 48. PMCID: PMC11719944. DOI: 10.3390/cells14010048 . https://www.ncbi.nlm.nih.gov/pubmed/39791749 本文引用 [1]

[30]	Fazeli P, Talepoor AG, Faghih Z, et al. The frequency of CD4⁺ and CD8⁺ circulating T stem cell memory in type 1 diabetes[J]. Immun Inflamm Dis, 2022, 10(10): e715. PMCID: PMC9500591. DOI: 10.1002/iid3.715 . https://www.ncbi.nlm.nih.gov/pubmed/36169248 本文引用 [1]

[31]

Jiang

, Ren

, Liang

, et al. HLA class I genes modulate disease risk and age at onset together with DR-DQ in Chinese patients with insulin-requiring type 1 diabetes[J]. Diabetologia, 2021, 64(9): 2026-2036. PMCID: PMC8382651. DOI: 10.1007/s00125-021-05476-6 .

https://www.ncbi.nlm.nih.gov/pubmed/34023962

本文引用 [2]

[32]

Zhu

, Xu

, Chen

, et al. Identification of novel T1D risk loci and their association with age and islet function at diagnosis in autoantibody-positive T1D individuals: based on a two-stage genome-wide association study[J]. Diabetes Care, 2019, 42(8): 1414-1421. DOI: 10.2337/dc18-2023 .

https://www.ncbi.nlm.nih.gov/pubmed/31152121

本文引用 [2]

[33]

Schirru

, Rossino

, Diana

, et al. HLA genotyping in children with celiac disease allows to establish the risk of developing type 1 diabetes[J]. Clin Transl Gastroenterol, 2024, 15(7): e00710. PMCID: PMC11272246. DOI: 10.14309/ctg.0000000000000710 .

https://www.ncbi.nlm.nih.gov/pubmed/38713138

本文引用 [1]

[34]	Li J, Zhang M, Zhang S, et al. CTSG polymorphisms in Chinese children with type 1 diabetes mellitus[J]. J Trop Pediatr, 2024, 70(4): fmae017. DOI: 10.1093/tropej/fmae017 . https://www.ncbi.nlm.nih.gov/pubmed/39122654 本文引用 [1]

[35]	Zhan S, Xu D, Ling C, et al. Screening of key pathogenic genes of type 1 diabetes in children[J]. Transl Pediatr, 2023, 12(4): 709-718. PMCID: PMC10167398. DOI: 10.21037/tp-23-201 . https://www.ncbi.nlm.nih.gov/pubmed/37181023 本文引用 [1]

[36]	Galderisi A, Carr ALJ, Martino M, et al. Quantifying beta cell function in the preclinical stages of type 1 diabetes[J]. Diabetologia, 2023, 66(12): 2189-2199. PMCID: PMC10627950. DOI: 10.1007/s00125-023-06011-5 . https://www.ncbi.nlm.nih.gov/pubmed/37712956 本文引用 [2]

[37]

Baidal

, Warnock

, Xu

, et al. Oral glucose tolerance test measures of first-phase insulin response and their predictive ability for type 1 diabetes[J]. J Clin Endocrinol Metab, 2022, 107(8): e3273-e3280. PMCID: PMC9282258. DOI: 10.1210/clinem/dgac285 .

https://www.ncbi.nlm.nih.gov/pubmed/35524749

本文引用 [1]

[38]	Jacobsen LM, Bundy BN, Ismail HM, et al. Index60 is superior to HbA1c for identifying individuals at high risk for type 1 diabetes[J]. J Clin Endocrinol Metab, 2022, 107(10): 2784-2792. PMCID: PMC9516117. DOI: 10.1210/clinem/dgac440 . https://www.ncbi.nlm.nih.gov/pubmed/35880956 本文引用 [1]

[39]

Nathan

, Redondo

, Ismail

, et al. Index60 identifies individuals at appreciable risk for stage 3 among an autoantibody-positive population with normal 2-hour glucose levels: implications for current staging criteria of type 1 diabetes[J]. Diabetes Care, 2022, 45(2): 311-318. PMCID: PMC8914436. DOI: 10.2337/dc21-0944 .

https://www.ncbi.nlm.nih.gov/pubmed/34853027

本文引用 [1]