A UK survey on the screening and management of childhood pre-clinical type 1 diabetes

Rabbi Swaby; Tabitha Randell; Claire Scudder; Jane Bowen-Morris; Julia Townson; Colin Dayan; Loredana Marcovecchio; Rachel Besser

doi:10.1530/endoabs.95.P24

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Endocrine Abstracts (2023) 95 P24 | DOI: 10.1530/endoabs.95.P24

BSPED2023 Poster Presentations Diabetes 1 (12 abstracts)

A UK survey on the screening and management of childhood pre-clinical type 1 diabetes

Rabbi Swaby ¹ , Tabitha Randell ² , Claire Scudder ¹ , Jane Bowen-Morris ³ , Julia Townson ⁴ , Colin Dayan ^1,5 , Loredana Marcovecchio ⁶ & Rachel Besser ^1,7

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Author affiliations

¹JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK; ²Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK; ³Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK; ⁴Centre for Trials Research, Cardiff University, Cardiff, UK; ⁵Clinical Diabetes and Metabolism, Cardiff University, School of Medicine, Cardiff, UK; ⁶Department of Paediatrics, University of Cambridge, Cambridge, UK; ⁷NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK

Introduction: Type 1 diabetes (T1D) onset may start years prior to clinical presentation. Screening children and young people (CYP) for T1D using islet autoantibodies (IAb) through research studies is gaining international momentum, since screening reduces diabetic ketoacidosis, hospitalisation and offers access to drug therapies for delaying T1D onset¹. Recently, ISPAD provided recommendations on monitoring for pre-clinical T1D in CYP, however no UK-specific guidelines or clinical care pathways exist¹. This survey aimed to gather information on clinicians’ experience of managing CYP with ≥ 1 IAb, who were not on insulin therapy.

Methods: We distributed an online survey through the BSPED newsletter to non-training substantive doctors (Feb-May 2023). Questions related to CYP with positive IAb and their clinical management over the preceding 2–3 years.

Results: There were 47 respondents; 35 responded as individuals, 12 on behalf of their entire unit. Sixteen respondents had been referred 36 CYP with positive IAb; 17 (47%) identified through clinical care, 19 (53%) through a research study. Reported management included a combination of HbA1c testing (27%), education on signs and symptoms of T1D (24%), capillary/venous glucose testing (18%), research study referral (13%), sensor glucose monitoring (11%), and no action (2.2%). Two respondents referred patients to a research study without clinical follow-up. Twenty-nine respondents reported ~200 parental requests for sibling IAb testing, over the preceding 2–3 years. In response, 32% provided reassurance, 52% referred to a research study, and 6% organised IAb testing in clinical care.

Discussion: Increasingly CYP in the UK are being screened for T1D in research studies and clinical care, with high demand for sibling testing, which will likely increase now that teplizumab is licensed in the US². However, the varied responses to referrals highlight the need for a UK consensus on monitoring and follow-up clinical care pathway.References1. Besser RE*, Bell KJ*, et al. ISPAD Clinical Practice Consensus Guidelines 2022 Stages of type 1 diabetes in children and adolescents. Pediatric diabetes. 2022;23(8):1175–1187.2. Quinn LM*, Swaby R*, et al. What does the licensing of teplizumab mean for diabetes care? Diabetes, Obesity and Metabolism. 2023;25(8):2051–2057 30. *Joint first authors