Endocrine Abstracts

Introduction: Children and young people (CYP) are increasingly being screened and identified with early-stage type 1 diabetes (T1D). Benefits of an earlier T1D diagnosis include a reduction in diabetic ketoacidosis, hospitalisation and a ‘softer landing’ into insulin therapy. Early-stage T1D is defined by having ≥2 islet autoantibodies (IAb), categorised into stage 1 (normoglycaemia), stage 2 (dysglycaemia), and stage 3 (hyperglycaemia). CYP with a single IAb are at risk of T1D. We present our experience of managing IAb-positive children in the UK’s first pre-T1D clinic.

Clinic set-up: Referrals were accepted from throughout the UK, criteria included CYP < 18 years, with ≥1 IAb and not on insulin therapy. Using a shared care model, appointments were offered face-to-face or virtually, with a multidisciplinary team. The Oxford pre-T1D follow-up pathway is risk-stratified based on patient age (<3, 3-9, >10 years) and T1D stage (single IAb, stage 1, stage 2), adapted from international guidelines. Follow-up involves a “light-touch” approach, using home glucose monitoring, HbA1c and unblinded continuous glucose monitoring. Service evaluation, including parental anxiety, is assessed by questionnaire, before and after the initial appointment. Risk status is flagged on both hospital and GP health records. Families are educated on home glucose testing and safety net thresholds are provided. Sensor glucose monitoring is used to guide the timing of insulin therapy.

Results: Of the 18 referrals, 13 patients have been seen, with advice provided to healthcare professionals in 5. Patients were identified equally from research platforms and clinical care. So far, 6/18 (33%) had a single IAb, and 12/18 (67%) had ≥2 IAb. Of the children with ≥2 IAb, 2/12 (17%) were in stage 1, 6/12 (50%) in stage 2 and (4/12) 33% were in stage 3, but not on insulin therapy. In follow-up, 8/18 (44%) children have been commenced on insulin therapy, all as outpatients, none in DKA. Questionnaires showed improvement in parental anxiety after the first clinic appointment (pre=3.6/5 vs post=2.5/5, where 1=not bothered, 5=bothered a great deal).

Discussion: We demonstrate the integration of follow-up of CYP with early-stage T1D into routine clinical care, allowing insulin to be started as an outpatient.