Type 1 diabetes often develops unnoticed. The immune system attacks the insulin-producing beta cells in the pancreas, frequently long before symptoms become apparent. During this early stage, characteristic islet autoantibodies can be detected in the blood. Screening for these autoantibodies can therefore identify children in whom the disease process has already begun, even though they are not yet showing any symptoms.
Early detection can offer significant benefits. When children with early-stage type 1 diabetes are identified and monitored regularly, the risk of diabetic ketoacidosis (DKA) at clinical onset can be substantially reduced. The onset of diabetes may then be less severe, and insulin treatment can be started promptly, often on an outpatient basis. Early diagnosis also gives families time to prepare for living with the condition and its treatment.
In addition, identifying type 1 diabetes before symptoms appear creates an opportunity to consider disease-modifying therapies at an appropriate stage and potentially delay the clinical onset of the disease.
The Majority of Children Who Develop Type 1 Diabetes Have No Family History
Screening people from families already known to be at high risk is not enough: more than 85 per cent of people newly diagnosed with type 1 diabetes have no family history of the condition. Moreover, once islet autoantibodies have been confirmed, the disease progresses at a similar rate regardless of family history.
The consensus recommends an initial screening between the ages of two and four years. If no islet autoantibodies are detected, further screening should take place between the ages of six and eight and again between the ages of 10 and 15. Studies show that islet autoantibodies first appear particularly frequently during these stages of childhood.
Within these age ranges, the timing of screening can be adapted to existing national or regional screening programmes. The recommendations also allow for a phased introduction: depending on local circumstances, programmes could initially focus on children at increased risk before being expanded to the wider population.
“With this international consensus, we have established a common framework for how population-wide screening for type 1 diabetes can be implemented in practice,” says Prof. Anette-Gabriele Ziegler, Director of the Institute for Diabetes Research at Helmholtz Munich and lead author of the consensus paper. “The diagnosis of early-stage diabetes is a step-by-step process: it begins with a sensitive screening test and is confirmed by highly specific second-line tests and a second blood sample. The specific design of the screening programme should be adapted to the respective healthcare system and, where possible, linked to existing screening programmes.”
Clear Communication and Support Are Essential
A confirmed diagnosis should be communicated to families in person and in a clear and empathetic manner. Psychosocial support should also be available when needed.
Separate international consensus recommendations already provide guidance on the regular monitoring of people diagnosed with early-stage type 1 diabetes.
The new recommendations have received broad international support. A total of 20 professional and patient organisations endorse the consensus paper, including the European Association for the Study of Diabetes (EASD), the International Society for Paediatric and Adolescent Diabetes (ISPAD) and the International Diabetes Federation Europe (IDF Europe).
Original Publication
Ziegler et al., 2026: International consensus guidance for general population screening for islet autoantibodies to diagnose early‑stage type 1 diabetes: a nominal group technique process, Diabetologia. DOI: 10.1007/s00125-026-06841-z
