Australia could become one of the first countries in the world to implement general population screening for T1D, thanks to an investment of nearly $10m from Breakthrough T1D, with support from the Australian Government through the Type 1 Diabetes Clinical Research Network (T1DCRN).
Screening for T1D
T1D can be detected early, before symptoms of the 4Ts show and insulin is required, through a simple blood test that identifies islet autoantibodies – markers that the immune attack leading to T1D has begun. We know that screening for T1D has lasting mental and physical health benefits including reduced risk of long-term complications of T1D (damage to other organs such as the eyes and kidneys) and diabetic ketoacidosis (DKA) when symptoms start.
In Australia, around a third of children with T1D are diagnosed in DKA, a serious health complication that can be fatal and is caused by late diagnosis of T1D. Screening for T1D and monitoring children in the early stages of T1D can help avoid this emergency situation.
Establishing population screening
Screening the entire Australian population is vital because 90% of people with T1D have no family history of the condition. But initiating a program of this nature requires careful planning. The healthcare system must be ready with labs that can run high numbers of blood tests, appropriate data collection systems, clinical care pathways for people who test positive for islet autoantibodies, and staff trained to facilitate all of this, before a sustainable program can be introduced. So, Breakthrough T1D is funding 3 projects to build the infrastructure, evidence base and clinical framework required for population T1D screening and monitoring in Australia.
Dr Dorota Pawlak, Chief Scientific Officer and Director of the T1DCRN, said: “Type 1 diabetes does not begin when symptoms appear — it begins months or even years earlier. We now have the scientific tools to detect the condition before symptoms appear, but we must ensure our health system is ready to act on that knowledge.”
“This investment represents a coordinated national effort to move T1D from crisis diagnosis to early detection, monitoring, and intervention with disease-modifying therapies we have on the horizon. By building the laboratory capacity, clinical pathways and evidence base required for population screening, we are laying the foundation for a future where no child is diagnosed in DKA and every person at risk is identified early and supported appropriately.”
Project 1: Australian Type 1 Diabetes National Screening Pilot
Led by Dr Kirstine Bell at the University of Sydney, this project aims to generate essential evidence in support of a national screening program for T1D in Australia. Building on the first phase of the pilot, which explored different potential screening methods, this 15-month initiative will assess the effectiveness, feasibility, acceptability, and cost-effectiveness of screening children for T1D.
The project will screen 7,500 children aged 4-12 years at school for islet autoantibodies, which are markers in the blood that the immune attack responsible for T1D has begun. The pilot will include partnerships with Indigenous and culturally and linguistically diverse communities to ensure all children are included in a culturally safe and appropriate way.
Project 2: Increasing capacity to identify Australians with early-stage T1D
Led by Professor John Wentworth at Royal Melbourne Hospital, this 3-year initiative will put the foundational laboratory, accreditation and system infrastructure in place for a sustainable and scalable T1D screening program in Australia. The project goals are to:
- optimise islet autoantibody screening tests within a clinical laboratory setting
- gain clinical accreditation (a certificate that ensures quality and safety) for an advanced, high-throughput islet autoantibody screening test to enable efficient large-scale screening
- expand existing screening for people with a family history of T1D through Type1Screen
- increase capacity to support general population screening
- build laboratory and data systems capable of supporting large-scale screening
- link to clinical trials networks to provide a pathway for people who screen positive to access emerging disease-modifying therapies to delay T1D onset
Professor Wentworth’s project will set up critical laboratory infrastructure for islet autoantibody testing in Australia to enable rapid and accurate family and general population T1D screening programs.
Project 3: Optimal care for people with early-stage T1D in Australia
The goal of this project is to implement an evidence-based model of care for individuals who test positive for early signs of T1D, known as early-stage T1D. People with early-stage T1D need to be monitored for signs that their T1D is progressing towards needing insulin to ensure timely clinical support. As screening expands, it is vital that Australia has a coordinated and consistent care model in place to prepare for the future impact of a national general population screening program.
Over 3 years, a research team led by Professor Jennifer Couper at Adelaide University will evaluate 8 clinical centres across Australia and compare models of care across different clinical settings to determine the most effective approaches for different settings. They will characterise the demographics of people being monitored, identifying barriers and enablers to care, and assessing how well centres are following international clinical guidelines.
By improving healthcare for people in the early stages of T1D and supporting people as they progress to needing insulin therapy, the program aims to reduce the rate of DKA at diagnosis. The research team will also establish a data platform that can collect and store data on people with early-stage T1D and link them to clinical trials networks to enable access to disease-modifying therapies that could slow or even one day prevent their T1D progressing.
Supporting a future national screening program
The 3 projects will run in tandem, with the lead researchers working together taking an evidence-based approach to prepare Australia for a sustainable, government-funded, and equitable national T1D screening program. Findings from this 3-pronged program of research are expected to inform public health policy and guide future applications to the Australian government to implement a national T1D screening program.
If successful, this would make Australia one of the world’s first countries to introduce population screening for T1D. This promises to improve health outcomes for everyone developing T1D in Australia now and in the years to come by preventing critical illness and enabling access to emerging prevention therapies for T1D.
