Endocrine Abstracts

JOINT2606

Introduction: Type 1 diabetes (T1D) demonstrates a distinctive early immunological signature, with approximately 80% of affected children developing multiple islet autoantibodies (IA) before age 5. These children face an 84% risk of progressing to symptomatic diabetes within 15 years. Population-based antibody screening presents a critical opportunity to identify preclinical T1D, enabling proactive intervention through family preparation for insulin therapy, prevention of diabetic ketoacidosis (DKA) at diagnosis, and timely initiation of disease-modifying treatments.

Research design and methods: The Antibody Detection Israeli Research (ADIR) program, launched in October 2021 with support from Breakthrough T1D, represents a comprehensive national screening initiative. The study targets 35,000 children aged 9 months to 5 years across Israel for IA screening, with longitudinal assessment planned for 5,000 participants through repeat screening. The program’s infrastructure comprises 65 community-based screening sites, six specialized diabetes centers following the children detected with preclinical T1D, a dedicated central laboratory, and a coordinating center. ADIR distinguishes itself through two key innovations: its focus on early childhood screening and the implementation of Antibody Detection by Agglutination PCR (ADAP) technology for autoantibody detection performed in capillary blood.

Preliminary results: As of January 2025, the study has enrolled 17,000 children (median age: 19 months). Analysis of over 12,000 samples revealed 57 children (0.475%) with multiple IA. Following confirmatory testing per the study protocol, 15 children were diagnosed with preclinical T1D, while others are still evaluated. Additionally, 120 children were identified with single islet antibody positivity. A comprehensive analysis and progression patterns will be presented.

Conclusions and future directions: The ADIR program represents one of the largest population-based screening initiatives for preclinical T1D in young children. Our preliminary results demonstrate the successful implementation of a nationwide screening infrastructure and validate the feasibility of early autoantibody detection using the novel ADAP technology. Identifying children with preclinical T1D and over 120 with single islet antibody positivity underscores the program’s potential for early intervention. These findings support the viability of large-scale screening programs for type 1 diabetes and establish a foundation for future preventive strategies. Long-term follow-up of this cohort will provide valuable insights into the natural history of T1D and create opportunities for early therapeutic intervention.