Pilot of opportunistic population screening for type 1 diabetes at pediatric routine well child visits

Objective: Autoantibody screening for type 1 diabetes provides an opportunity to improve outcomes. Existing screening programs have not explored integration into pediatrics via opportunistic screening, or screening conducted as part of another blood draw. Here, we aimed to assess the status of screening in one health system, develop a program for opportunistic screening in pediatrics, and pilot the program to assess feasibility and identify real-world barriers. Research Design and Methods: The Geisinger system electronic health record was queried for pediatric patients who had pancreatic autoantibody testing and relevant patients were manually reviewed to determine if testing was completed as screening. To assess the potential of implementing opportunistic autoantibody screening into existing pediatric workflows, a pilot screening plan was implemented as an observational cohort study at a pediatric primary care clinic. Interviews were conducted post-pilot implementation to gather feedback on pilot implementation. Results: As of 2022, prior to screening pilot, of 312,824 pediatric patients, nine completed autoantibody testing as type 1 diabetes screening. An opportunistic autoantibody screening pilot was implemented in a pediatric primary care clinic between March and April 2024. During the pilot, of 120 eligible patients, 26% (n = 31) were enrolled and 19 (16% total eligible participants) completed screening. Post-pilot interviews identified barriers to screening and potential strategies to improve future implementation. Conclusions: Type 1 diabetes screening was rarely performed. An opportunistic screening model in primary care was demonstrated to be feasible and could increase adoption of screening across the population with additional strategies to address identified barriers. Article Highlights: · Why did we undertake this study? o To explore implementation of type 1 diabetes screening via routine blood draws (opportunistic screening) in primary care. · What is the specific question(s) we wanted to answer? o How often is type 1 diabetes screening performed in a single health system? Can we develop and evaluate an opportunistic type 1 diabetes screening program in pediatric primary care? · What did we find? o Type 1 diabetes screening in the system was limited. We designed and implemented an opportunistic pilot with a minimum uptake of 26%. · What are the implications of our findings? o An opportunistic screening model in primary care is feasible and can increase adoption of screening. Widespread adoption will require additional strategies to overcome the barriers and promote facilitators identified in this pilot.