Impact of screening programmes for type 1 diabetes in youth: A systematic review and meta-analysis

Aim: To evaluate the impact of anti-islet antibody (IAb) screening on the general population and first-degree relatives (FDRs)/high-risk individuals and evidence-based follow-up modalities. Methods: We performed this review through systematic searches of PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform between 15 March 2006, and 15 March 2025. We selected studies on children and adolescents screened for T1D IAbs, compared with people who were not screened or IAb+ individuals who were not followed up. PICOS framework was used in the selection process. Outcome data were extracted, and a meta-analysis of DKA risk at T1D onset was performed. Quality of evidence was assessed using the GRADE approach. This study was registered with PROSPERO, CRD42024523781. Results: Sixty-six studies, 53 of moderate-to-high quality, were included. Screening was associated with lower DKA rates by 23% (95% CI 18-29%, I2 = 88.8%). The risk of stage 3 T1D progression was high in younger children with persistent and/or multiple IAb+. Screening was associated with higher indicators of parental anxiety, which decreased during follow-up. Children with IAb positivity were monitored according to age and T1D stage, using HbA1c, oral glucose tolerance testing and continuous glucose monitoring (CGM). Time above 140 mg/dL was a biomarker of progression. Conclusions: Population screening with IAbs and follow-up of IAb+ individuals helps decrease DKA and allows participation in intervention trials. This systematic review provides evidence for clinical practice on the screening timing, modalities and follow-up. Further studies on the use of CGM are expected.