Childhood diabetes screening could cut emergency cases, study shows

Screening children for type 1 diabetes could help prevent thousands of emergency diagnoses, according to results from the UK’s largest study of its kind, published this week in The Lancet Diabetes & Endocrinology.

The Early Surveillance for Autoimmune diabetes (ELSA) study found that testing children for diabetes-related autoantibodies can detect the condition years before symptoms develop.

This potentially avoids cases where children first present in diabetic ketoacidosis (DKA) - a life-threatening crisis that leads to emergency admission, with Diabetes UK noting that over a quarter of children are diagnosed only once they are already in DKA.

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Early detection ensures children can start insulin therapy promptly when needed, reducing the risk of emergency presentation. The findings also suggest that routine screening could enable earlier intervention and access to immunotherapy, which may delay disease progression.

The research, led by the University of Birmingham and co-funded by Diabetes UK and Breakthrough T1D, screened 17,283 children aged three to 13 years, testing blood samples for autoantibodies – signs of the immune system attack that can appear years before symptoms.

Children with two or more autoantibodies almost always progress to insulin dependency, a stage known as early-stage type 1 diabetes. Those with one autoantibody have a 15% chance of developing the condition within 10 years.

The process identified 160 with early-stage type 1 diabetes and seven with undiagnosed type 1 diabetes requiring immediate insulin therapy. A further 75 had an elevated risk of developing the condition.

The study reported strong public acceptance of screening, with more than 37,000 families signing up, including many with no family history of diabetes.

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While parents initially reported anxiety following positive results, education and ongoing support helped families feel informed and prepared.

The findings suggest that screening could also provide earlier access to disease-modifying treatments, including teplizumab, which can delay the need for insulin by around three years for some people with early-stage type 1 diabetes.

The drug was licensed in the UK in August 2025 but is not yet routinely available on the NHS.

Diabetes UK and Breakthrough T1D have now awarded £1.5m to fund ELSA 2, which will expand screening to all children aged two to 17 years and recruit another 30,000 participants.

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The second phase will also establish new NHS early-stage type 1 diabetes clinics to provide clinical and psychological support, aiming to create a clear pathway from screening to diagnosis, monitoring and treatment.

Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, said: 'The ELSA study, co-funded by Diabetes UK, is generating the evidence needed to make type 1 diabetes screening a reality for every family in the UK.’