UK best practice recommendations for children and young people <18 years with pre-stage 3 type 1 diabetes, on behalf of the British Society for Paediatric Endocrinology and Diabetes (BSPED).

Screening for childhood type 1 diabetes (T1D) is increasing worldwide. Historically, screening has been undertaken through research programmes, but increasingly in the UK, children and young people are also being tested in clinical care. This identifies children before the onset of clinical disease through measurement of four islet autoantibodies (IAb): anti-glutamic acid decarboxylase; anti-insulin; anti-IA2 tyrosine phosphatase; and anti-zinc transporter-8. Otherwise well individuals confirmed to have ≥2 IAb have early-stage T1D, meaning that they are in the pre-symptomatic phase of the disease. This is categorised into stages, where stage 1 indicates ≥2 IAb and normoglycaemia, and stage 2 the presence of ≥2 IAb and dysglycaemia. Stage 3 T1D indicates that the diagnostic threshold for T1D has been reached, which may occur with or without symptoms of diabetes. The goal of screening and monitoring programmes is to reduce the adverse clinical consequences of diabetic ketoacidosis at diagnosis and to identify children who may benefit from disease-modifying therapies to delay or reverse progression to insulin requirement. Additional benefits include avoiding hospitalisation and preparation for the 'softer landing' into T1D. To seek these benefits, children should be monitored; yet many individuals decline follow-up in a research context. We therefore describe a pathway suitable for children identified from both screening programmes and clinical care settings. The pathway consists of 5 themes (IAb confirmation, monitoring of individuals in early-stage T1D, starting insulin, monitoring in single IAb positivity, and audit standards against which the pathway can be assessed during implementation).