1168-P: First-Degree Relatives with High-Risk Islet Autoantibodies Less Likely to Engage in Follow-up

Background: Follow-up monitoring of islet autoantibody positive (IA+) persons is critical to early T1D identification, including prevention of diabetic ketoacidosis. We identified factors predicting completion of an initial follow-up monitoring visit after confirming high-risk IA+ (i.e., single IA+ by two methods or multiple IA+).

Methods: The Autoimmunity Screening for Kids (ASK) program screens youth aged 1-17 for IA and offers a free monitoring program if the child is identified as IA+. Multiple logistic regression was used to identify factors associated with completing the initial monitoring visit among youth identified as high-risk for progressing to T1D (i.e., single IA+ by two methods or multiple IA+).

Results: Seventy-nine percent (N=194/246) of youth completed an initial monitoring visit. Controlling for child age, sex, IA status, and race/ethnicity, youth with a first-degree relative with T1D (i.e., parent or sibling) were significantly less likely to participate in the monitoring visit (OR 0.39, p=0.04).

Conclusion: Youth at high-risk for progression to T1D with FDRs were less likely to participate in the ASK follow-up monitoring program compared to individuals without FDRs. These findings are consistent with the TEDDY study which found FDRs were less likely to complete OGTTs and food records. Potential explanations include FDRs are more confident monitoring for signs/symptoms and therefore feel the visits are less necessary. Alternatively, the burden of caring for another individual with T1D already may make follow-up for the individual identified as high-risk less feasible. Further research is needed to better understand reasons FDRs are less engaged in follow-up after being identified as high-risk for T1D. Interventions tailored to address concerns of FDRs may help increase engagement in programs monitoring high-risk IA+ children for progression to clinical T1D.