A new international consensus statement offers recommendations for general population screening of children for early-stage type 1 diabetes (T1D), starting with ensuring that the appropriate infrastructure is in place.

The writing panel was convened by Breakthrough T1D and endorsed by 20 other societies, including the European Association for the Study of Diabetes, International Society of Pediatric and Adolescent Diabetes, and Association of Diabetes Care and Education Specialists, along with several other country-specific diabetes associations.

The new guidance follows a previous one from the same panel published in 2024, regarding the management of people who have already been screened either independently or in family-member screening programs such as TrialNet and have tested positive for T1D-related autoantibodies.

“The first document was related to monitoring, [which is] essential for realizing the benefits of screening, like reducing the risk for [diabetic ketoacidosis] at diagnosis, or offering approved therapies, or engaging in clinical trials,” Anastasia Albanese-O’Neill, PhD, vice president of Medical Affairs for Breakthrough T1D, told Medscape Medical News.

“This new document is the second pillar,” she said. “If we only screen family members, we won’t reach the majority of people who will go on to receive a diagnosis of T1D because approximately 85% of people have no family history or first-degree relatives with the disease.”

The document “International consensus guidance for general population screening for islet autoantibodies to diagnose early‑stage type 1 diabetes” was recently published online in Diabetologia. 

Infrastructure Comes First

“The first step isn’t screening but making sure that you have the infrastructure in place for the follow-up monitoring,” said Albanese-O’Neill.

The guidance points out that policy and infrastructure necessary for general-population screening include the ability to confirm positive results, monitor those with early-stage T1D, and make appropriate interspecialty referrals.

If these are in place, the statement authors suggest that a “practical starting point” would be targeted screening of people at increased risk, such as those with personal history of autoimmune disease or family history of T1D or other autoimmune diseases.

Early Stages of T1D

Other recommendations also address specifics about the testing, including sensitivity, specificity, validation, confirmatory testing, laboratory standards, and minimizing false-positive and false-negative results.

The statement suggests that universal screening should take place in pediatric patients at age 2-4, and if found islet autoantibody (IAb)-negative, again at age 6-8, and at 10-15. Catchup can be done at any time, and the ages can be adapted to established public health activities such as well child visits or vaccination clinics. Less evidence is available for early-stage T1D in people older than 15 years, but a one-time screen can be considered.

The stages of T1D are:

• Stage 0: Positive for a single IAb with normoglycemia (10th revision of the International Classification of Diseases [ICD-10] code E10.A0)
• Stage 1: Positive for two or more IAbs with normoglycemia (E10.A1 or R76)
• Stage 2: Usually 2 or more IAbs with dysglycemia (E10.A2 or R76 accompanied by R73.0)
• Stage 3: Clinical T1D, with IAb present and persistent hyperglycemia with or without symptoms (E10.9)

The guidance also addresses issues around psychosocial support, including how to communicate the test results, and referral of patients and families, if needed.

Another section on cost-effectiveness summarizes currently available data, including studies from Colorado and Bavaria, Germany, suggesting that cost savings could potentially come from prevention of diabetic ketoacidosis, improved A1c, and where available, use of teplizumab (Tzield, Sanofi) to delay T1D onset.

Not All Support Universal Screening

Asked for comment on behalf of the American Diabetes Association (ADA), Joshua J. Neumiller, PharmD, CDCES, ADA senior vice president of medical affairs, told Medscape Medical News that for now, the ADA continues to recommend more targeted T1D screening.

“The 2026 ADA Standards of Care recommend that autoantibody-based screening for presymptomatic type 1 diabetes be offered to individuals with a family history of type 1 diabetes or with otherwise known elevated genetic risk. In those with one or more IAbs, the importance of early diagnostic testing to avoid delays in treatment is emphasized. Furthermore, identification of individuals with stage 2 type 1 diabetes allows for consideration of teplizumab therapy to delay the onset of symptomatic stage 3 type 1 diabetes in appropriate candidates,” Neumiller said.

Also asked for comment, a spokesperson for the American Academy of Pediatrics (AAP) told Medscape Medical News, “This is a topic of conversation among AAP experts, but the organization does not have policy or early screening recommendations at this time.”

Anne L. Peters, MD, professor of clinical medicine, Department of Endocrinology/Internal Medicine at the University of Southern California, Los Angeles, said that she does not support universal population screening for early T1D at this time.

“Screening for T1D can be very important for identifying children at higher risk for developing the disease. However, screening has not been well tested in diverse populations,” she told Medscape Medical News.

“Universal screening in resource-poor, lower-risk populations may not be a good use of scarce healthcare resources. And all screening must be done in the context of access to counseling and education for individuals who screen positive and their caregivers,” she said.

Peters declared serving as a director, officer, partner, employee, advisor, consultant, or trustee for Vertex and receiving research grants from Insulet Corporation, Abbott Diabetes Care, and Zucara Therapeutics.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and Bluesky @miriametucker.bsky.social.