Endocrine Abstracts

Introduction: Type 1 diabetes (T1D) can begin years before clinical presentation. Screening children and young people (CYP) for T1D using islet autoantibodies (IAb) is increasingly popular, as screening reduces diabetic ketoacidosis, hospitalisation and offers access to drug therapies for delaying T1D onset. ISPAD and the INNODIA/GPPAD/FR1DA consortium have provided recommendations for monitoring early-stage T1D (defined as pre-symptomatic with ≥2 IAb). However, no UK-specific guidelines exist, nor for the management of CYP with a single IAb. This survey gathered information on the frequency and management of CYP with ≥1 IAb who are not on insulin.

Methods: We distributed an online survey across the UK’s four nations via paediatric diabetes networks (March 2024 – June 2024). Lead clinicians responded on behalf of their unit. Data on prevalence, IAb frequency, clinical management, and sibling testing were collected.

Results: Of 188 units contacted (172 from England and Wales, 11 from Scotland, 5 N Ireland), 84/188 (45%) responded: 76/172 (44%) England and Wales, 4/11 (36%) from Scotland and 4/5 (80%) Northern Ireland. Thirty-six percent (30/84) of units reported managing 111 CYP with ≥ 1 IAb, not on insulin: 39/111 (35%) with a single IAb, and 72/111 (65%) with ≥ 2 IAb. CYP were identified from secondary (47%) and primary care (6%), as well as research platforms (47%). Reasons for early identification included family screening (42%), clinical symptoms suggestive of new-onset diabetes (37%) and following an autoimmune screen (21%). Clinical management included: providing education (23%), glycaemic assessment (18%) and referral to a research study (12%). To assess glycaemic status, clinicians used: HbA1c testing (32%), self-monitored glucose (14%), sensor glucose monitoring (14%), and OGTT (15%). Clinicians reported that if requested to test an unaffected sibling’s diabetes risk, 17% would organise IAb testing in clinical care, 61% would refer to a research study, and 17% would not test, and reassure.

Discussion: CYP with early-stage T1D are increasingly being identified in the UK from research platforms, and primary/secondary clinical care settings. The prevalence of screening outside research platforms highlights the need for a UK consensus on a monitoring and follow-up clinical care pathway.