Remote and in-clinic models target early type 1 diabetes screening | ADA 2026

Two studies presented at the 2026 American Diabetes Association Scientific Sessions point toward a future in which early type 1 diabetes (T1D) screening is both scalable and routine. One moves the entire process into patients' homes; the other embeds it into pediatric clinics’ daily operations.

Early detection of stage 1 and stage 2 T1D is key to heading off diabetic ketoacidosis (DKA), which occurs in approximately 60% of pediatric cases at diagnosis. Yet traditional screening depends on invasive blood draws and remains inconsistent across care settings. Both research teams set out to remove those barriers, and both reported that no DKA events occurred among participants, an early signal that operationalizing screening can improve outcomes.

A fully remote, genetics-first model

Researchers launched what they described as the first fully remote T1D screening program, which is built around a novel genetic risk score (GRS) designed for large-scale use. The GRS draws on a specific single-nucleotide polymorphism (SNP) panel that requires no imputation, a feature the team flagged as central to potential FDA approval, and achieved an area under the curve above 0.9 using 300 T1D cases and more than 10,000 controls.

The workflow relies on at-home saliva collection, which feeds a fully automated central laboratory capable of processing more than 1,000 samples per day. More than 1,000 first-degree relatives were enrolled in a prospective cohort and received at-home genetic testing, annual autoantibody testing via dried blood spots and virtual psychosocial support from certified counselors.

Participants stratified as high risk by the GRS had 10 times the odds of testing positive for multiple autoantibodies compared with the low-risk group, a difference the authors noted is significant given that nearly all participants were first-degree relatives. The investigators also reported that remote genetic counseling reduced participant anxiety over time, which they cited as evidence that a decentralized model can be delivered safely.

Operationalizing screening inside the clinic

A separate multicenter quality improvement effort tackled the same problem from the operational side. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) set out to raise screening rates by 15% and monitoring by 30% from baseline across four pediatric centers over an 18-month period.

Teams used standard quality improvement tools, including process mapping, fishbone diagrams and Plan-Do-Study-Act cycles, to target barriers through family education, workflow optimization and provider engagement and reported monthly on screening volumes, autoantibody status, staging and interventions. The 15% screening goal was exceeded by mid-2024, with growth peaking in mid-2025.

In total, 596 screenings identified 194 autoantibody-positive individuals; 48 met stage 1 criteria, and 49 met stage 2. A total of 101 patients were offered monitoring, and 46 received teplizumab, with no DKA reported.

The studies point to complementary routes to earlier detection. The remote program offers a cost-effective blueprint for population-level screening that identifies at-risk individuals early and allocates resources more efficiently, according to its authors. The quality improvement initiative shows that structured operational strategies can make screening sustainable within existing clinical workflows.