Abstract
Introduction and Objective: With the 2022 FDA approval of a disease-modifying therapy for the delay of stage 3 T1D, enthusiasm for T1D screening has grown. However, it remains unclear if healthcare practitioners are prepared to implement islet autoantibody screening and metabolic monitoring for relatives of people with T1D and, eventually, the general population. The objective was to assess current practices focusing on relatives of people with T1D. Methods: We surveyed U.S. endocrinologists within the T1DX-QI, a national collaborative focused on improving clinical outcomes for individuals with T1D. Over 60 medical centers who care for people with T1D were surveyed regarding current T1D screening and monitoring practices of which 38 pediatric and 18 adult centers responded (84% academic centers, 16% safety net hospitals), representing 91,694 individuals with T1D. Results: Eighty-four percent of pediatric centers screen for T1D, compared to only 39% of adult centers. Additionally, 66% of pediatric centers have monitoring programs for islet autoantibody-positive individuals compared to only 39% of adult centers, likely an underestimate due to selection bias. A major barrier to clinical implementation is limited or lack of insurance coverage for autoantibody testing in individuals not under the ordering practitioner's care (i.e., relatives of people with T1D). As a result, 42% of pediatric and 72% of adult centers cannot order commercial autoantibody testing within their state/health system. Pediatric practices report having greater access to islet autoantibody screening programs under research protocols than do adult practices (71% vs 39%). Conclusion: Many pediatric and even more adult diabetes centers are not able to screen and monitor at-risk individuals. These insights highlight existing gaps and the need for targeted strategies to enhance screening accessibility and monitoring across healthcare systems.