Type 1 Diabetes National Screening Pilot: Monitoring Children with Early Stage Type 1 Diabetes

Type 1 diabetes is a lifelong autoimmune condition. There are two very early stages of type 1 diabetes (stage 1 and stage 2) that arise when the autoimmune disease is triggered but symptoms are not yet present. These two pre symptomatic stages can be detected through screening for type 1 diabetes-specific autoantibodies. International clinical guidelines recommend monitoring children with early stage type 1 diabetes to detect progression to stage 3 and allow for timely commencement of insulin therapy before children develop life-threatening diabetic ketoacidosis. The feasibility and acceptability of these new clinical guidelines have not yet been assessed in the Australian paediatric type 1 diabetes population. This study aims to assess the implementation of these new guidelines as part of care for children in the Pilot. This study will follow each participant for 3 years from the start of recruitment. Children with single or multiple diabetes specific auto-antibodies, detected through the National Screening Pilot, will be monitored for dysglycaemia via random blood glucose and HbA1c levels by their local paediatric diabetes team. Children with multiple antibodies will also be offered 2-week periods of continuous glucose monitoring (CGM) at intervals over the 3 years. Single Antibody Children aged 36 months or younger - 6 monthly HbA1c, glucose and antibody measurements (30min to 1h) Single Antibody Positive Children aged over 36 months - 12 monthly HbA1c, glucose and antibody measurements (30min to 1h) Multiple Antibody Positive Children aged 36 months or younger - 3 monthly HbA1c, glucose and CGM - study visit 30min to 1h Multiple Antibody Positive Children aged over 36 months - 6 monthly HbA1c, glucose and CGM - study visit 30min to 1h Adherence to study visits and monitoring as well as attrition rates will be recorded to assess feasibilty and acceptability of the monitoring guidelines. In order to assess feasibility and acceptability, parents will also be offered curated surveys at each monitoring study visit to understand the acceptability of monitoring. Attrition rates will also be assessed as a measure of feasibility and acceptability. Surveys will be sent electronically before and after the monitoring visit and are estimated to take approximately 15min to complete. The number of completed surveys will be used to assess acceptability of these surveys.