Vienna — A panel of experts from the European Association for the Study of Diabetes (EASD) has recommended general population screening for early-stage type 1 diabetes (T1D) beginning at age 2-4 years. 

Only about 15% of children who develop T1D have a first-degree family member with the condition, making universal screening necessary for early identification of the majority of affected individuals, explained panel member Anette-Gabriele Ziegler, MD, director of the Institute of Diabetes Research, Helmholtz, Munich.

An autoimmune condition, T1D is now known to develop in three stages. In stage 1, the person has two or more islet autoantibodies (IAbs) but blood sugar is still normal. In stage 2, there is autoimmunity and dysglycemia but no symptoms. Stage 3 is the clinical diagnosis of overt T1D, with autoimmunity and pronounced hyperglycemia until insulin treatment is given. Children in stage 1 have about a 44% likelihood of progressing to stage 3 T1D within 5 years, and those in stage 2 have a 75% chance. 

Screening Recommendations

The EASD panel recommends that — where policy and infrastructure are in place — IAb screening using commercially available IAb assays should be offered to the general population. Screening should begin with children aged 2-4 years, and if IAb is negative, it should be repeated at 6-8 years and at 10-15 years. Less is known about progression to T1D in the population older than 15 years, although teenagers may be screened if they haven’t been previously. Repeat tests are recommended for those who screen positive. 

Prior to starting such a screening program, the panel recommends, “there must be developed infrastructure for 1) confirmation of positive results, and 2) monitoring for those with early stage T1D, including referral pathways between primary and secondary care, and between pediatric and adult services, as needed.” 

A draft of the new recommendations was presented here at the EASD 2025 Annual Meeting by several of the writing panel members. The document will be submitted for peer review and publication. Other relevant medical organizations are also reviewing it for possible endorsement. 

A similar process was used for a previous consensus statement from some of the same panel members regarding management of people who screen positive, panel chair Anastasia Albanese-O’Neill, PhD, APRN, CDCES, director of community screening and clinical trials education at Breakthrough T1D, told Medscape Medical News.

Population T1D screening programs are already in place in Germany, Italy, Israel, the UK, and elsewhere, including some regions of the United States such as Colorado. Screening of first-degree relatives of patients with T1D has long been available through the international network TrialNet. 

While targeted screening of people at increased risk due to personal or family history of autoimmune disease may be a practical starting point, the ultimate goal is general population screening, said Ziegler.

Panel member Marian Rewers, MD, PhD, professor of pediatrics at the University of Colorado and executive director of the Barbara Davis Center for Diabetes Pediatric Clinic, Aurora, said that the expected benefits of population screening for T1D include the enabling of metabolic monitoring to avoid the development of diabetic ketoacidosis at the time of stage 3 onset; the opportunity to receive disease-modifying therapy such as teplizumab, with more options expected soon; and the opportunity to participate in clinical trials of novel interventions to stop or slow progression to insulin dependence. 

Possible harms — such as increased anxiety, false positive results or false reassurance following a negative screen, and stigma from an early-stage diagnosis — can all be mitigated, said Rewers. 

Cost and Infrastructure Concerns

Timothy J. Lyons, MD, professor of medicine at the Medical University of South Carolina, Charleston, and executive medical director of Diabetes Free South Carolina, said that cost would likely be a problem, at least in the United States. 

“[If] you're going to screen the entire population, that’s a lot of people,” he said. In the United States, where a lot of money is spent on healthcare, “we don't do a good job of preventive healthcare. This would be preventive healthcare. We need to spend more money on that and less money on expensive end-stage disease.”

“If you get a positive test, you have to confirm it,” Lyons noted, and this would require “a lot of time and manpower, interpreting it correctly, and communicating it back to the patients.” 

While it may work well in systems with universal healthcare and structured care for children, “we have very few ways to deliver population-wide healthcare in the US,” he added. “We have fragmented healthcare systems and competing agencies. It would have to be paid for by Medicaid, and right now that’s challenging.” 

Rewers recently published a review paper on the cost of T1D screening. He noted that some analyses found cost-effectiveness for early T1D screening due to the health benefits, particularly reduction in diabetic ketoacidosis incidence, and that future availability of more disease-modifying drugs may improve the outlook. Nonetheless, real-world results may differ by state and healthcare systems, as well as other factors. 

The EASD guidance advises that IAb testing be embedded into established public health activities such as vaccination clinics and well-child clinic appointments, said panel member and EASD President Chantal Mathieu. 

“It is expected that different healthcare services will adopt the screening context that is most appropriate to their regional public health goals,” she said, adding that “IAb screening should promote equity of access for all individuals, independent of socioeconomic status, ethnicity, or regional location.” 

Mathieu also said that where this screening is offered, providers should be knowledgeable about the process including the effective communication of results and any necessary referrals, and “it is expected that adequate reimbursement for these activities is available.” 

Mathieu reported serving or having served on advisory panels for Abbott, Bayer, Biomea Fusion, Boehringer Ingelheim, Eli Lilly, Insulet, Medtronic, Novartis, Novo Nordisk, Roche, SAB Bio, Sanofi, and Vertex (financial compensation paid to institution); receiving research support to institution from ActoBio Therapeutics, Medtronic, Novo Nordisk, and Sanofi; serving or having served on speakers bureau for Abbott, Dexcom, Eli Lilly, Medtronic, Novo Nordisk, Roche, Sanofi, and Vertex (financial compensation paid to institution). Ziegler serves on advisory panels and Data Monitoring Committee for Sanofi. Lyons, Rewers, and Albanese-O’Neill have no disclosures. 

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 (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social