Population‐Based Screening for Type 1 Diabetes in Czechia: Results From the First 1% of the Paediatric Population
Barbora Berka, Ondřej Cinek, Vít Neuman, Klára Hubáčková, Agáta Čermáková, Andrea Radková, Samuel Owoeye, Maximilian Goetz, Florian Haupt, Peter Achenbach, Jurgen Vercauteren, Lutgart Overbergh, Chantal Mathieu, Anette‐Gabriele Ziegler, Zdeněk Šumník,ABSTRACT
Aims
EDENT1FI is a European initiative aiming to implement a roadmap for screening, monitoring and prevention of childhood Type 1 diabetes (T1D). The Betty project is a nationwide T1D screening program recently established in Czechia within the framework of EDENT1FI. Here we report its results after having tested 1% of the Czech paediatric population.
Methods
The screening targets children aged 2–17.9 years, regardless of whether they have a family history of T1D. It follows a two‐step process for detecting islet‐specific autoantibodies (anti‐GAD, anti‐IA2, anti‐ZnT8 and IAA). If the capillary screening sample is positive in the first‐level test (screening ELISA yielding a summary signal of three autoantibodies), the same sample is retested at the EDENT1FI reference laboratory using a battery of 4 second‐level tests for individual autoantibodies (LIPS or RBA). When any autoantibody is detected, a venous sample is requested for confirmation. If multiple autoantibodies are confirmed from this venous sample, the child is diagnosed with early‐stage T1D and offered follow‐up tailored to their individual estimated rate of progressing to clinical diabetes. Children with only a single confirmed autoantibody are offered a less intensive follow‐up outside the EDENT1FI protocol.
Results
The Betty project collected 19 044 capillary screening samples (1% of the paediatric population) between April 2024 and February 2026. Samples were collected across 270 screening sites mostly at primary care and via home sampling (4.1% samples). The majority of participants (89.7%) were from the general population having no first‐degree relative (FDR) with T1D. We found a prevalence of multiple autoantibodies of 0.39% (95% CI: 0.30%–0.51%) in the general population and 2.8% (95% CI: 2.1%–3.7%) prevalence among FDRs of subjects with T1D. At the time of writing, of 201 children with non‐negative capillary screening sample, 102 were diagnosed with early‐stage T1D by a confirmatory venous sample and 83 had their T1D stage assessed: 77 (93%) were in Stage 1, 4 (4.8%) in Stage 2 and 2 (2.4%) in Stage 3. Further seven children, who were identified by capillary screening, manifested with Stage 3 T1D before their staging could be completed. All families who came for staging and education visits consented to long‐term follow‐up.
Conclusions
This nationwide T1D screening program successfully reached approximately 1% of the Czech paediatric population, demonstrating the feasibility of implementing population‐based islet autoantibody screening based on the common EDENT1FI protocol. These findings provide an important foundation for the potential future implementation of routine population‐based T1D screening within the Czech national healthcare system and offer valuable insights for other countries considering similar screening programmes.