A major UK study has shown that screening children for type 1 diabetes can diagnose the condition in its earliest stages, before symptoms appear.
Results from the first phase of the ELSA (Early Surveillance for Autoimmune Diabetes) study, co-funded by Breakthrough T1D and Diabetes UK, have been published in The Lancet Diabetes & Endocrinology. The findings pave the way for a UK-wide screening programme that could transform how type 1 diabetes (T1D) is diagnosed and managed.
Currently, more than a quarter of children are diagnosed in diabetic ketoacidosis (DKA), a life-threatening emergency requiring urgent hospital care. Early detection through screening can dramatically reduce these emergencies and open access to new treatments that can delay the need for insulin by years.
Led by researchers at the University of Birmingham, the study tests blood samples for autoantibodies, which are markers of type 1 diabetes that can appear years before symptoms; risk rises sharply with the number of autoantibodies. Children without autoantibodies are unlikely to develop T1D, while those with one autoantibody have a 15% chance of developing the condition within 10 years. Having two or more autoantibodies indicates the immune system has already started attacking the insulin-producing cells in the pancreas and it is almost certain these children will eventually need insulin therapy.
Among the 17,283 children aged 3-13 years who were screened for type 1 diabetes risk at the time of analysis:
- 75 had one autoantibody, signalling increased future risk.
- 160 had two or more autoantibodies but did not yet require insulin therapy, indicating early-stage type 1 diabetes.
- Seven were found to have undiagnosed type 1 diabetes with all needing to start insulin immediately.
Families of children found to have early-stage type 1 diabetes received tailored education and ongoing support to prepare for the eventual onset of type 1 diabetes symptoms. This enables insulin therapy to begin promptly when needed, reducing the chances of needing emergency treatment. Children with one autoantibody also received ongoing support and monitoring.
Some families have also been offered teplizumab, the first ever immunotherapy for type 1 diabetes, which can delay the need for insulin by around three years in people with early-stage T1D. Teplizumab was licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK in August 2025 but is not yet available routinely on the NHS.
Building on this strong foundation, the second phase of the research launches in January 2026. ELSA 2 will expand screening to all children in the UK aged 2-17 years, with a focus on younger children and older teenagers. The research team aims to recruit 30,000 additional children across these new age groups.
ELSA 2 will also establish new NHS Early-Stage Type 1 Diabetes Clinics, providing families with clinical and psychological support, creating a clear pathway from screening to diagnosis, monitoring and treatment.
Lead researcher, Parth Narendran, Professor of Diabetes Medicine at the University of Birmingham, said: “We are extremely grateful to all the families who have participated in the study and generously given their time to help understand how a UK-wide screening programme could be developed. Together with Diabetes UK, Breakthrough T1D and the National Institute for Health and Care Research, we are working towards a future where type 1 diabetes can be detected in a timely manner, and families appropriately supported and treated with medicines to delay the need for insulin.”
For more information about ELSA visit elsadiabetes.nhs.uk
- Quinn LM, Elliott J, Papanikolaou T, et al. Feasibility of general population screening for type 1 diabetes in the UK: the ELSA study. Lancet Diabetes Endocrinol. 2026. Published online 20 January. doi:10.1016/S2213-8587(25)00363-8