P-15: Feasibility and outcomes of targeted islet autoantibody screening in high-risk pediatric populations: a Bulgarian pilot initiative
N Yaneva, M Archinkova, M Petrova, A Yordanova, T Popov, D Kyurkchiev, E KurtevaAbstract
Introduction
Presymptomatic screening for Type 1 diabetes reduces diabetic ketoacidosis risk and enables early disease-modifying interventions. Despite rising type 1 diabetes incidence in Bulgaria, systematic screening programs remain absent.
Objectives
To evaluate the feasibility of selective screening for Type 1 diabetes in Bulgarian children with and without family history, and identify potential clinical associations with islet autoimmunity.
Methods
This pilot study targeted 250 children aged 0-18 years (200 with first-degree relatives with type 1 diabetes, 50 without family history). Screening for five islet autoantibodies (glutamic acid decarboxylase, insulin, insulinoma-associated-2, zinc transporter-8 and islet cell cytoplasmic autoantibodies) was performed using chemiluminescence immunoassay. Positive participants were scheduled for longitudinal follow-up. Clinical factors including breastfeeding, allergic status, diet, infection frequency and autoimmune history were assessed.
Results
Between October 2024 and February 2026, 210 participants were recruited (84% of target): 160 with affected relatives and 50 without. Seven children (4.4%) in the high-risk group tested positive for single autoantibodies (3 glutamic acid decarboxylase, 2 zinc transporter-8, 1 insulinoma-associated-2, 1 insulin autoantibodies), while none were detected in children without family history. No multiple autoantibody positivity or stage 3 type 1 diabetes cases were identified. No significant associations were observed between autoantibody positivity and assessed clinical factors.
Conclusions
This pilot demonstrates feasibility of selective type 1 diabetes screening in Bulgaria with high public engagement. While no significant clinical correlations emerged, the framework establishes foundation for larger longitudinal studies and provides a scalable model for standardized early detection programs.