The European Association for the Study of Diabetes (EASD) is urging health systems to introduce population-wide screening for type 1 diabetes in young children, starting between ages two and four.
Most children who go on to develop the condition do not have a close family history of the disease.
In fact, only about 15 per cent have a first-degree relative with the condition, said Anette-Gabriele Ziegler, MD, director of the Institute of Diabetes Research, Helmholtz, Munich. This, she explained, makes broad-based testing essential for early detection.
Researchers now describe type 1 diabetes as a progressive autoimmune disease with three distinct phases.
In the first, children carry two or more islet autoantibodies (IAbs) but still have normal blood sugar. In stage two, autoimmunity is combined with abnormal glucose levels but without symptoms.
The third stage marks full clinical diabetes, with hyperglycaemia requiring insulin therapy. Children in stage one have around a 44 per cent chance of developing clinical diabetes within five years, while stage two carries a 75 per cent risk.
The EASD group recommends IAb testing with commercially available assays for the general population, provided local infrastructure allows.
Initial testing should take place between ages two to four. If negative, it should be repeated at six to eight years and again between 10 to 15 years.
While less is known about disease development in people over 15, adolescents can still be screened if they have not been tested previously. Repeat testing is advised for those who initially screen positive.
According to the panel, before launching such programmes, “there must be developed infrastructure for one) confirmation of positive results, and two) monitoring for those with early-stage type 1 diabetes, including referral pathways between primary and secondary care, and between paediatric and adult services, as needed.”
These draft recommendations were shared at the EASD 2025 Annual Meeting. They will now be submitted for peer review and possible endorsement by other medical bodies.
A similar process was used for an earlier statement on the management of people who test positive, said panel chair Anastasia Albanese-O’Neill, PhD, APRN, CDCES, director of community screening and clinical trials education at Breakthrough T1D.
Population-based programmes are already underway in countries such as Germany, Italy, Israel and the UK, as well as in selected US states including Colorado.
Relatives of people with type 1 diabetes can also access testing through TrialNet – a long-standing international network.
While targeted approaches may be useful at first, “the ultimate goal is general population screening,” said Ziegler.
Marian Rewers, MD, PhD, professor of paediatrics at the University of Colorado and executive director of the Barbara Davis Center for Diabetes Paediatric Clinic, explained the expected benefits.
These include monitoring to prevent diabetic ketoacidosis at diagnosis, access to emerging treatments such as teplizumab and opportunities to enrol in trials of therapies that may delay progression to insulin dependence.
He also noted that potential downsides – including anxiety, false positives, false reassurance, or stigma from an early diagnosis – “can all be mitigated.”
In the US, cost remains a sticking point. “[If] you’re going to screen the entire population, that’s a lot of people,” said Timothy J. Lyons, MD, professor of medicine at the Medical University of South Carolina and executive medical director of Diabetes Free South Carolina. In a healthcare system that spends heavily on treatment rather than prevention, he added: “We need to spend more money on that and less money on expensive end-stage disease.”
Lyons stressed that every positive test requires confirmation, which demands considerable resources and expertise: “a lot of time and manpower, interpreting it correctly, and communicating it back to the patients.” He also highlighted the difficulty of implementing nationwide screening in a fragmented US system where Medicaid would likely have to fund it.
Rewers has published research suggesting that early screening could be cost-effective by reducing cases of diabetic ketoacidosis, though results may vary between regions and health systems. The arrival of more disease-modifying therapies could further strengthen the case.
EASD President Chantal Mathieu said the best approach would be to integrate IAb testing into existing public health services such as vaccination visits or well-child clinics. “It is expected that different healthcare services will adopt the screening context that is most appropriate to their regional public health goals,” she explained. She also emphasised that “IAb screening should promote equity of access for all individuals, independent of socioeconomic status, ethnicity, or regional location.”
Mathieu added that healthcare professionals offering screening must be trained to handle testing, explain results clearly, and arrange appropriate referrals, and that “it is expected that adequate reimbursement for these activities is available.”
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