This population-based analysis used data from the German multicenter DPV diabetes registry to examine whether regional screening initiatives for early-stage type 1 diabetes (T1D) were associated with diabetic ketoacidosis (DKA) rates at disease manifestation. The analysis was published in the Pediatric Diabetes. Children aged 0.5 to <15 years diagnosed with T1D between 2015 and 2023 were included and allocated to federal states (FSs) based on residence. Relative risks (RRs) for DKA were calculated using logistic regression.

A total of 24,408 children (54.3% male) with median onset age 8.8 years (quartiles 5.3–11.8) were analyzed. Overall, DKA risk did not differ significantly between FSs with versus without screening initiatives (RR 0.96; 95% CI 0.93–1.03; p=0.393). In a subgroup with the highest probability of being screened (children aged 1.75–10.99 years in Bavaria, 2020–2023), DKA risk was lower (RR 0.88; 95% CI 0.80–0.97; p=0.012). Age <3 years was the strongest predictor of DKA (RR 1.83; 95% CI 1.66–2.03; p<0.001).

Limitations include lack of individual screening participation data, variation in screening implementation timing, and potential influence of other awareness initiatives.

Regional screening was not associated with reduced DKA at population level through 2023. Increased screening coverage may be necessary to assess potential future impact.