Abstract Body

The natural history of type 1 diabetes is well defined, and early stages of type 1 diabetes are defined by the presence of multiple type 1 diabetes associated autoantibodies (glutamic decarboxylase antibody, insulinoma antigen-2 antibody, insulin antibody, and zinc transporter 8 antibody). Internationally, the number of programs screening for early stages of type 1 diabetes through the measurement of type 1 diabetes associated autoantibodies continues to increase. In addition, all four major type 1 diabetes associated autoantibodies can be measured commercially in many countries. With increased screening and detection of individuals who are in early stages of type 1 diabetes, there is a need to provide routine clinical follow up to keep patients medically safe, reduce the risk of diabetic ketoacidosis, counsel on risk of disease progression and identify individuals who may be eligible for interventions. In a research setting, oral glucose tolerance tests, metabolic risk scores, HbA1c measurement, blood glucose testing and continuous glucose monitors may be used to monitor disease progression. It is unknown whether these tools used during follow-up visits in a research setting will be technically, economically or operationally feasible in a clinical setting. Whether our current monitoring strategies are feasible in a clinical setting is also dependent on the demand for such follow-up, which hinges on the successful implementation of screening individuals for early stages of type 1 diabetes. We will review experience from our general population screening program in Colorado, the Autoimmunity Study in Kids, as well as our Early Type 1 Diabetes Clinic to examine the acceptability, implementation, practicality and integration of the use of various monitoring tools in the clinical setting. We will also discuss how current monitoring strategies may be adapted to improve feasibility in a clinical setting.