Population‐Based Screening for Type 1 Diabetes in Czechia: Results From the First 1% of the Paediatric Population

AIMS: EDENT1FI is a European initiative aiming to implement a roadmap for screening, monitoring and prevention of childhood Type 1 diabetes (T1D). The Betty project is a nationwide T1D screening program recently established in Czechia within the framework of EDENT1FI. Here we report its results after having tested 1% of the Czech paediatric population. METHODS: The screening targets children aged 2-17.9 years, regardless of whether they have a family history of T1D. It follows a two-step process for detecting islet-specific autoantibodies (anti-GAD, anti-IA2, anti-ZnT8 and IAA). If the capillary screening sample is positive in the first-level test (screening ELISA yielding a summary signal of three autoantibodies), the same sample is retested at the EDENT1FI reference laboratory using a battery of 4 second-level tests for individual autoantibodies (LIPS or RBA). When any autoantibody is detected, a venous sample is requested for confirmation. If multiple autoantibodies are confirmed from this venous sample, the child is diagnosed with early-stage T1D and offered follow-up tailored to their individual estimated rate of progressing to clinical diabetes. Children with only a single confirmed autoantibody are offered a less intensive follow-up outside the EDENT1FI protocol. RESULTS: The Betty project collected 19 044 capillary screening samples (1% of the paediatric population) between April 2024 and February 2026. Samples were collected across 270 screening sites mostly at primary care and via home sampling (4.1% samples). The majority of participants (89.7%) were from the general population having no first-degree relative (FDR) with T1D. We found a prevalence of multiple autoantibodies of 0.39% (95% CI: 0.30%-0.51%) in the general population and 2.8% (95% CI: 2.1%-3.7%) prevalence among FDRs of subjects with T1D. At the time of writing, of 201 children with non-negative capillary screening sample, 102 were diagnosed with early-stage T1D by a confirmatory venous sample and 83 had their T1D stage assessed: 77 (93%) were in Stage 1, 4 (4.8%) in Stage 2 and 2 (2.4%) in Stage 3. Further seven children, who were identified by capillary screening, manifested with Stage 3 T1D before their staging could be completed. All families who came for staging and education visits consented to long-term follow-up. CONCLUSIONS: This nationwide T1D screening program successfully reached approximately 1% of the Czech paediatric population, demonstrating the feasibility of implementing population-based islet autoantibody screening based on the common EDENT1FI protocol. These findings provide an important foundation for the potential future implementation of routine population-based T1D screening within the Czech national healthcare system and offer valuable insights for other countries considering similar screening programmes.