Healthcare professionals' experience with early‐stage (stage 1 and 2) type 1 diabetes and readiness for immunotherapies in adults: A UK ‐based survey

BACKGROUND: Type 1 diabetes progresses through presymptomatic early stages defined by islet autoantibody positivity and glycaemia. Early detection reduces ketoacidosis and facilitates access to disease-modifying therapies. The extent to which autoantibody screening and follow-up have been adopted in UK clinical practice for adults is uncertain. METHODS: We conducted a web-based survey of members of the Association of British Clinical Diabetologists (ABCD), Diabetes Technology Network UK (DTN-UK) and Primary Care Diabetes and Obesity Society (PCDOS) between 12 December 2025 and 2 February 2026. RESULTS: Of 164 complete responses, 116 (71%) were from doctors, 40 (24%) from nurses and 8 (5%) from other healthcare professionals. The majority were from district general hospitals (n = 91, 56%), followed by tertiary centres (n = 31, 19%), community-based and private specialist diabetes services (n = 14, 9%) and general practice (n = 28, 17%). Thirty-five per cent (11/31) in tertiary centres and 21% (22/105) in other care settings reported experience in managing adults with early-stage T1D. Among these clinicians, HbA1c was the most commonly used follow-up method (73% in tertiary centres and 86% in other settings), while approximately half offered capillary blood glucose and ketone meters and/or continuous glucose monitoring. In general practice, access to islet autoantibody testing was limited, and few had local guidelines for managing stage 1 or 2 T1D. In diabetes specialist practice, autoantibodies to GAD, IA-2 and ZnT8, but not insulin, were the most widely requested islet autoantibody assays. Perceived readiness to implement immunotherapy was low across all settings. CONCLUSIONS: Early-stage T1D management is evolving within UK clinical practice. Monitoring and management practices broadly align with consensus recommendations. Education, national guidance and clear commissioning frameworks will be essential for successful provision of immunotherapies.