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Published on: May 29, 2020
Integrating a Research-Based Type 1 Diabetes Autoantibody Screening Protocol Into an Economically and Culturally
Honora Quinn Burnett1, Christina Studts2, Holly M Frost3
1Denver Health, Department of Pediatrics (HQ Burnett, S O'Leary and Y Gottlieb), Denver, CO; University of Colorado School of Medicine (HQ Burnett, Y Gottlieb, and S O'Leary), Denver, CO.
Objective:
To integrate screening for early type 1 diabetes (T1D) into well child care (WCC) at a diverse, urban FQHC using PRISM/RE-AIM to assess feasibility, reach, and implementation barriers in a population historically underrepresented in T1D screening research.
Methods:
We conducted an 8-month pragmatic implementation study embedding Autoimmunity Screening for Kids (ASK) early T1D screening into WCC for children aged 12 to 24 months. Implementation strategies included staff training, workflow integration, and culturally tailored educational materials. Outcomes were evaluated across RE-AIM dimensions.
Results:
Of 359 eligible children, caregivers of 86 (24%) provided research consent and children completed laboratory draws. Screened participants reflected the clinic population: 77% Hispanic/Latino and 28% Spanish-speaking. One child, who screened islet auotanibody positive (1%), was connected to follow-up care. All 13 clinicians completed training and ordered at least 1 screening test, but sustained adoption was concentrated among a subset of providers. Implementation challenges included limited visit time, competing priorities, difficulty conducting informed consent within WCC, and workflow disruptions related to research protocol requirements. Caregivers expressed strong support for early identification. Screening numbers remained stable but below targets, and research protocol deviations ultimately halted screening.
Conclusions:
Embedding research-based T1D screening into this FQHC was feasible but not sustainable due to structural, workflow, and research-specific demands. Findings highlight key barriers and contextual considerations necessary for future population-based islet cell autoantibody screening initiatives in primary care settings.
