Bringing early detection to life: real-world operationalization of a presymptomatic type 1 diabetes screening and monitoring pilot program

Objective This pilot project served as a proof of concept to assess the operational feasibility of integrating presymptomatic type 1 diabetes screening and monitoring, using islet autoantibody (AAB) testing, into routine clinical care at two pediatric T1D Exchange Quality Improvement Collaborative (T1DX-QI) centers. Additionally, it identified care team perceptions of operational challenges and surveyed healthcare teams’ readiness in the T1DX-QI. Research design and methods Over an 18-month period, this initiative focused on developing and optimizing workflows, provider and patient education, technological integration, and health equity, utilizing quality improvement methodologies. Focus groups were conducted to identify care team perceptions of operational challenges via Zoom. Prior to project start, a cross-sectional survey was administered among T1DX-QI centers to assess screening and monitoring readiness. Results Workflows for screening and monitoring were tested over time at the two centers, both developing process maps. A total of 147 individuals were screened during 12 months of active screening. No episodes of diabetes-related ketoacidosis were reported among those screened with confirmed positive results. Key facilitators of implementation identified during focus groups included enhanced interdisciplinary communication, streamlined insurance processes, and improvements to electronic health record systems. Challenges included limited clinical resources, variable patient engagement, and inconsistent insurance coverage. Readiness survey results highlighted that pediatric centers were twice as likely to conduct screening and reported greater access to results from research screening programs. Conclusions Findings from this pilot offer critical insights into the practical implementation of presymptomatic type 1 diabetes screening and monitoring programs in diverse clinical environments. Despite identified barriers, continuous quality improvement efforts, along with identified facilitators to success, led to an increase in the number of individuals screened and monitored. Future work will focus on expanding these efforts across diverse care settings, with strategies to support sustainability beyond pilot phases.