Integrating a Research-Based Type 1 Diabetes Autoantibody Screening Protocol Into an Economically and Culturally...

Area of Science:

• Implementation science
• Pediatric endocrinology
• Public health

Background:

• Type 1 diabetes (T1D) screening in diverse urban populations is underrepresented in research.
• Early identification of T1D can improve patient outcomes.
• Integrating screening into routine well child care (WCC) is a potential strategy.

Purpose of the Study:

• To assess the feasibility, reach, and implementation barriers of early T1D screening within WCC at an urban Federally Qualified Health Center (FQHC).
• To utilize the PRISM (Practice-oriented research to improve healthcare systems) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) frameworks for evaluation.

Main Methods:

• An 8-month pragmatic implementation study embedded the Autoimmunity Screening for Kids (ASK) T1D screening into WCC for children aged 12-24 months.
• Implementation strategies included staff training, workflow integration, and culturally tailored educational materials.
• Outcomes were evaluated using the RE-AIM dimensions.

Main Results:

• Of 359 eligible children, 86 (24%) had research consent and completed lab draws, reflecting the clinic's diverse population (77% Hispanic/Latino, 28% Spanish-speaking).
• One child (1%) screened positive for islet autoantibodies and was connected to follow-up care.
• While clinicians completed training, sustained adoption was limited, and screening ultimately halted due to protocol deviations and workflow challenges.

Conclusions:

• Embedding T1D screening into FQHC WCC was feasible but not sustainable due to structural, workflow, and research demands.
• Key barriers included limited visit time, competing priorities, informed consent difficulties, and research protocol disruptions.
• Findings highlight crucial contextual factors for future population-based islet autoantibody screening initiatives in primary care.