Screening Programs for Type 1 Diabetes in Youth: Evidence for Clinical Practice

Studies of individuals at risk for developing type 1 diabetes (T1D) have demonstrated that the disease is a continuum that progresses sequentially through distinct identifiable stages before the onset of symptoms. Screening for islet antibodies (IAbs) in at-risk children for T1D (first-degree relatives or those with human leukocyte antigen genetic risk) and in the general population is becoming increasingly common in some countries. The main aim of the T1D screening program is to reduce rates of diabetic ketoacidosis (DKA) at diagnosis and to participate in research protocols that receive T1D-modifying therapies to delay clinical onset. These advantages are generally balanced with the psychological symptoms (such as anxiety and depression) that this information could produce in healthy children-adolescents and their parents, and the costs of the screening. Optimal ages for performing IAb screening in the general population have been established by cohort analyses in several studies. Primary care physicians can be responsible for family enrollment and capillary blood sampling in the general population. For follow-up of individuals who screen positive for IAbs, both age and the number of IAbs detected influence how frequently and intensively monitoring is recommended, as well as whether referral to a specialist care center is advised. Measures considered for monitoring include IAbs, hemoglobin A1c, random blood glucose, oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM). This article describes how such evidence has been implemented in Italy, offering practical insights into integrating screening into routine pediatric care.