Pediatricians rank top strategies for screening children for type 1 diabetes in primary care

Primary care pediatricians have helped identify the practical tools they say would make it feasible to screen children with a family history for early-stage type 1 diabetes, in a pre-implementation study published in BMC Health Services Research. The work, part of a project called Screening to Early Detection of Type 1 Diabetes (STEP T1D), used the rapid assessment process to co-select implementation strategies with the providers who would carry out testing in everyday practice.

The study responds to a shift in clinical guidance. Since 2023, screening for early-stage type 1 diabetes and monitoring for disease progression has been recommended to prevent severe complications at diagnosis and to open pathways to disease-modifying therapies. Yet screening has so far been limited largely to academic diabetes centers. Recent guidance supports screening in primary care, but the researchers note that evidence on optimal approaches in that setting remains limited, which motivated the study’s aim: to identify pediatrician-informed strategies for implementing type 1 diabetes screening in primary care for children with a family history of the disease.

The team conducted five visits to pediatric primary care practices representing diverse environments. Data collection at each visit included 60-minute facilitated group discussions and provider surveys. During the discussions, pediatricians reflected on how screening would be integrated into their workflows, with a focus on possible solutions. The survey presented 18 established implementation strategies, which providers rated on a 1-to-5 Likert-type scale from “very unhelpful” to “very helpful.” Detailed field notes were analyzed using a taxonomic approach to identify how strategies might address organizational barriers and facilitators to screening, and strategies with mean scores above 4.5 out of 5 were considered highly prioritized.

Group discussions with 29 primary care providers surfaced three facilitators. First, the pediatricians expressed high general support for screening as falling within their scope of practice. Second, they pointed to existing referral systems to pediatric endocrinology. Third, they identified practice-based support to follow up on test results as an asset they could build on.

The barriers the providers raised centered on four practical challenges: identifying who to screen, the ease of carrying out testing, counseling families about results, and access to follow-up care for families with high social needs. These concerns shaped which implementation strategies rose to the top of the survey ratings.

The highly prioritized strategies focused on five concrete tools: creating order sets for diabetes antibodies with embedded diagnosis codes; step-by-step protocols; electronic health record customizations such as prompts and documentation templates; a quick reference guide for common terms; and support from endocrinology. Field notes from the facilitated discussions of proposed strategies aligned with and expanded on these survey findings.

The authors conclude that strategies to implement type 1 diabetes screening in primary care should focus on clinical decision support tools combined with access to expert consultation. They also emphasize that future research should evaluate the impact of these strategies on uptake of screening and on long-term sustainability, since the current study was designed to prepare for implementation rather than to measure screening outcomes.

As a pre-implementation study based on a small number of practices and 29 providers, the findings describe the priorities and perspectives of the participating pediatricians rather than the effectiveness of any strategy in practice. The study was not a clinical trial, and the researchers note that the proposed strategies now require evaluation to determine whether they translate into higher screening rates and durable integration into primary care. The article is published open access, with the accepted version shared early and subject to further edits before the final version of record.

Subject of Research: Implementation strategies for type 1 diabetes screening in pediatric primary care

Article Title: Screening to early detection of type 1 diabetes (STEP T1D): co-selection of implementation strategies with primary care pediatricians using the rapid assessment process

Article References: Orris, S., Ganoe, M., Pangburn, M., Schoemer, P., Libman, I., & March, C. A. (2026). Screening to early detection of type 1 diabetes (STEP T1D): co-selection of implementation strategies with primary care pediatricians using the rapid assessment process. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15910-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15910-3

Keywords: type 1 diabetes, screening, primary care, pediatrics, implementation science, rapid assessment process, electronic health records, clinical decision support, pediatric endocrinology, pre-implementation study, early, detection