Endocrine Abstracts

Type 1 diabetes (T1D) can be identified pre-symptomatically, by measuring islet associated autoantibodies (IAb). In an analysis from multiple prospective cohort studies, >80% children with two or more IAbs developed clinical T1D over 15 years of follow up. The reasons for identifying children presymptomatically include reducing the risk of diabetic ketoacidosis at diagnosis and the related morbidity and mortality, reducing the need for hospitalisation, providing time to allow a smoother transition to insulin therapy, and to offer individuals opportunities to trial new treatments to delay T1D onset. Until recently, screening programmes using IAb have been limited to first degree relatives (FDRs), because of the ten-fold increased risk of T1D compared to the general population. However, the knowledge that more than 85% children with T1D do not have an affected FDR, has been a driving force in establishing general population screening programmes globally. Already in the UK children with IAb are being identified by clinical and research teams. However, the benefits of screening can only be realised if linked to a monitoring and follow-up programme. In this talk, we will discuss an approach to managing the child with positive IAb in clinical practice.