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Objective Adolescence is associated with high risk hyperglycaemia. This study examines the phenomenon in a life-course context. Research design and methods 93,125 people with type 1 diabetes aged 5-30 years were identified from the National Diabetes Audit (NDA) and/or the National Paediatric Diabetes Audit (NPDA) for England and Wales for 2017/18-2019/20. For each audit year the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analysed in sequential cohorts by year of age. Results In childhood, unreported HbA1c measurement was uncommon but by 19 years had increased to 22.3% for males and 17.3% for females, reducing to 17.9% and 13.1% respectively by 30 years. Median HbA1c at 9 years was 7.6% (60mmol/mol) (IQR 7.1%-8.4%, 54-68mmol/mol) in males and 7.7% (61mmol/mol) (8.0%-8.4%, 64-68mmol/mol) in females increasing to 8.7% (72mmol/mol) (7.5%-10.3%, 59-89mmol/mol) and 8.9% (74mmol/mol) (7.7%-10.6%, 61-92mmol/mol) respectively at 19 years before falling to 8.4% (68mmol/mol) (7.4%-9.7%, 57-83mmol/mol) and 8.2% (66mmol/mol) (7.3%-9.7%, 56-82mmol/mol) respectively at 30 years. Annual hospitalisation for DKA rose steadily from 6 years (2.0% for males, 1.4% for females) to peak at 19 years for males (7.9%) and 18 years for females (12.7%) reducing to 4.3% for males and 5.4% for females at 30 years. At all ages over 9 years the prevalence of DKA was higher in females. Conclusions HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.

OBJECTIVE Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context. RESEARCH DESIGN AND METHODS A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018–2019/2020. For each audit year, the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age. RESULTS In childhood, unreported HbA1c measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA1c for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1–8.4%, 54–68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0–8.4%, 64–68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5–10.3%, 59–89 mmol/mol) and 8.9% (74 mmol/mol) (7.7–10.6%, 61–92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4–9.7%, 57–83 mmol/mol) and 8.2% (66 mmol/mol) (7.3–9.7%, 56–82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals. CONCLUSIONS HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.

Most screening programs to identify individuals at risk for type 1 diabetes have targeted relatives of people living with the disease to improve yield and feasibility. However, ~90% of those who develop type 1 diabetes do not have a family history. Recent successes in disease modifying therapies to impact the course of early-stage disease have ignited the consideration of the need for and feasibility of population screening to identify those at increased risk. Existing population screening programs rely on genetic or autoantibody (AA) screening, and these have yielded significant information about disease progression and approaches for timing for screening in clinical practice. At the March 2021 Type 1 Diabetes TrialNet Steering Committee meeting, a session was held in which ongoing efforts for screening in the general population were discussed. This report reviews the background of these efforts and the details of those programs. Additionally, we present hurdles that need to be addressed for successful implementation of population screening and provide initial recommendations for individuals with positive screens so that standardized guidelines for monitoring and follow-up can be established.