General population screening for type 1 diabetes using islet autoantibodies at the preschool vaccination visit: a proof-of-concept study (the T1Early study)

Scudder, Claire, Townson, Julia ORCID: https://orcid.org/0000-0001-8679-3619, Bowen-Morris, Jane, Gillespie, Kathleen, Evans, Philip, Jones, Sarah, Thomas, Nicholas P. B., Stanford, Jane, Fox, Robin, Todd, John A., Greenfield, Sheila, Dayan, Colin M. ORCID: https://orcid.org/0000-0002-6557-3462 and Besser, Rachel E. J. 2024. General population screening for type 1 diabetes using islet autoantibodies at the preschool vaccination visit: a proof-of-concept study (the T1Early study). Archives of Disease in Childhood 109 , pp. 812-817. 10.1136/archdischild-2023-326697

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Abstract

Objective: Type 1 diabetes (T1D) screening programmes testing islet autoantibodies (IAbs) in childhood can reduce life-threatening diabetic ketoacidosis. General population screening is required to detect the majority of children with T1D, since in >85% there is no family history. Age 3–5 years has been proposed as an optimal age for a single screen approach. Design: Capillary samples were collected from children attending their preschool vaccination and analysed for IAbs to insulin, glutamic acid decarboxylase, islet antigen-2 and zinc transporter 8 using radiobinding/luciferase immunoprecipitation system assays. Acceptability was assessed using semistructured interviews and open-ended postcard questionnaires with parents. Setting: Two primary care practices in Oxfordshire, UK. Main outcome measures: The ability to collect capillary blood to test IAbs in children at the routine preschool vaccination (3.5–4 years). Results: Of 134 parents invited, 66 (49%) were recruited (median age 3.5 years (IQR 3.4–3.6), 26 (39.4%) male); 63 provided a sample (97% successfully), and one participant was identified with a single positive IAb. Parents (n=15 interviews, n=29 postcards) were uniformly positive about screening aligned to vaccination and stated they would have been less likely to take part had screening been a separate visit. Themes identified included preparedness for T1D and the long-term benefit outweighing short-term upset. The perceived volume of the capillary sample was a potential concern and needs optimising. Conclusions: Capillary IAb testing is a possible method to screen children for T1D. Aligning collection to the preschool vaccination visit can be convenient for families without the need for an additional visit.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Start Date: 2024-06-26, Type: open-access
Publisher:	BMJ Publishing Group
ISSN:	0003-9888
Date of First Compliant Deposit:	2 July 2024
Date of Acceptance:	8 June 2024
Last Modified:	13 Nov 2024 15:31
URI:	https://orca.cardiff.ac.uk/id/eprint/170223

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