OBJECTIVES:Thiamine-responsive megaloblastic anemia (TRMA) is a rare but clinically impactful disorder caused by pathogenic SLC19A2 variants. Despite its characteristic triad - megaloblastic anemia, non-autoimmune early-onset diabetes, and sensorineural hearing loss - TRMA is frequently unrecognized at initial presentation, delaying life-altering treatment. This report highlights how early thiamine therapy can rapidly reverse dysglycemia and hematologic abnormalities, and how diagnostic delay may permit irreversible neurological injury. CASE PRESENTATION:Case 1, a six-month-old male, presented with diabetic ketoacidosis and profound anemia. High-dose thiamine produced a striking metabolic response: near-immediate glycemic stabilization, complete insulin discontinuation within days, and normalization of hematologic parameters. Despite optimal early treatment, progressive hearing loss necessitated cochlear implantation. Case 2, a three-year-old male, exhibited recurrent anemia, difficult-to-control diabetes despite insulin therapy, and established sensorineural hearing impairment, following a stroke at age two. Thiamine initiation after delayed genetic confirmation improved dysglycemia and corrected anemia, yet neurological sequelae remained fixed. CONCLUSIONS:These cases underscore TRMA as a high-impact, reversible cause of early-onset diabetes - but only when recognized promptly. Thiamine can induce complete metabolic remission and insulin independence, offering a therapeutic opportunity unmatched in most pediatric diabetes etiologies. However, once neurological damage develops, metabolic correction alone is insufficient. TRMA should be urgently considered in any child with recurrent macro/megaloblastic anemia and atypical or antibody-negative diabetes, especially with hearing concerns. Early genetic testing and immediate thiamine therapy are essential to prevent avoidable, lifelong morbidity. In children with unexplained megaloblastic anemia and atypical diabetes, immediate TRMA screening may prevent irreversible complications.

Introduction Metabolic dysfunction–associated steatotic liver disease (MASLD) is a recognized cardiometabolic risk factor in adults, but its relevance to early vascular remodeling in youth with type 1 diabetes (T1D) remains unclear. We evaluated the independent associations of hepatic fat and body composition with early structural vascular remodeling in youth with T1D. Methods This cross-sectional study included 49 late-pubertal youth with T1D (mean age 16.1±2.6 years; duration 7.5±4.3 years). Hepatic fat was quantified using MRI–proton density fat fraction (PDFF), while body composition and estimated insulin sensitivity (eIS) were assessed using dual-energy X-ray absorptiometry and a validated pediatric equation. Carotid intima–media thickness (cIMT), measured by ultrasound, served as the primary outcome. Hierarchical linear regression assessed independent associations after adjustment for age, sex, and diabetes duration. Results Mean hepatic fat was 1.87±1.22%, with no participants meeting criteria for steatosis. Hepatic fat, eIS, and diabetes duration were not associated with cIMT. Lean body mass was the primary independent associate of cIMT (β=0.44, p=0.02). Although eIS was strongly associated with waist circumference (r=−0.76, p<0.001), neither variable was associated with cIMT. Conclusions In this sub-steatotic cohort, cIMT was primarily associated with lean body mass, reflecting physiologic growth, while central adiposity was associated with metabolic dysfunction but not vascular structure.

Introduction and Objective: Diabetes ketoacidosis prevention requires timely ketone management during illness, pump site failures, and insulin omission. Despite routine education, many families rely on emergency call lines before initiating self-management. We aimed to improve patient self-efficacy and reduce ketone-related calls through individualized, evidence-based ketone action plans (KAPs). Methods: Guided by the Model for Improvement, we performed root cause analysis and subsequently developed and implemented KAPs for insulin pump and multiple daily injection users in a large pediatric diabetes center. Process measures included provider documentation of KAPs and provider feedback. Outcome measures included patient utilization and perception. Balancing measures included hypoglycemic events. Data were reviewed through iterative Plan-Do-Study-Act (PDSA) cycles to refine both KAP content and implementation workflow. Results: Factors limiting ketone self-management identified by root cause analysis included clinic culture, 24/7 call line access, variability among provider recommendations, variability among societal guidelines, and fear among patients, caregivers and providers. While 860 patients received KAPs, only 47% of KAPs were documented in the EHR. Following implementation, ketone-related emergency calls decreased by 7%. Families (n=24) reported high comfort and ease of use (mean 1.2 and 1.1 on 5-point Likert scale). One hypoglycemic event was reported among KAP users. Providers (n=30) felt comfortable implementing KAPs but reported challenges with time, comprehension for those with low health literacy, and variations in ketone dose suggestions. Conclusion: Individualized KAPs fostered patient confidence and reduced call volume without increasing adverse events. However, provider non-documentation and workflow challenges limit scalability. Future PDSA cycles will target EHR integration, provider time constraints, and explore expansion to schools. Disclosure J.T. Hooven-Davis: None. A. Miyagusuku Chang: None. L.M. Cervenak: Other - Certified pump trainer-independently contracted; Current; Tandem Diabetes Care, Inc. K.M. Fantaskey: Employee; Current; Insulet Corporation. A. Gilliland: None. R. Grecek: None. O. Krolczyk: Stock/Shareholder; Current; Dexcom, Inc., Medtronic. Consultant; Current; Tandem Diabetes Care, Inc. Stock/Shareholder; Current; Tandem Diabetes Care, Inc. I. Libman: None. B. Vu-Boast: None. Funding NIDDK (T32DK138882 - 10/25 to present), NICHD (T32HD081834 - 8/2024-9/2025)

Introduction and Objective: Automated insulin delivery (AID) systems improve glycemia but show high variability in individual outcomes. The aim was to identify predictors of glycemic patterns in youth after AID initiation. Methods: We used group-based trajectory modeling to characterize groups based on 18 months of glycemic data using CGM-determined % time in range (TIR) in youth ages 6-18 with T1D. Multivariable multinomial logistic regression estimated associations between clinical and sociodemographic predictors and trajectories. Results: Four TIR trajectories emerged among 713 AID users (Figure 1). All groups showed improvement, but only a small subset (Group 4) achieved and sustained TIR >70%. Compared to Group 4, Group 1 (lowest TIR) was older, had longer T1D duration, greater socioeconomic disadvantage (Area Deprivation Index), bolused less, and entered fewer carbohydrates at baseline. After adjusting for covariates including age, sex, T1D duration, and prior treatment, participants with fewer self-initiated boluses [OR 0.39 (95% CI: 0.28, 0.53)] and fewer appointments [OR 0.36 (0.16, 0.79)] had higher odds of Group 1 than Group 4. Higher insulin doses/kg [OR 1.53 (1.25, 1.88)] and greater parent inter-visit communication [OR 1.13 (0.99, 1.29)] were associated with increased odds of Group 1 membership. Conclusion: Distinct glycemic trajectories following AID initiation exist. Access to care and modifiable factors are strongly associated with trajectory group. Disclosure J.T. Hooven-Davis: None. C.M. Lalama: None. S.A. Syer: None. S.D. Rothenberger: None. I. Libman: None. C. March: None. Funding NICHD T32HD081834ISPAD- Breakthrough T1D Fellowship Award

Though school-partnered interventions have the potential to improve health outcomes, data are limited to support their implementation for type 1 diabetes. The objective was to characterize barriers and facilitators (i.e., determinants) to implementing school-partnered collaborative care (SPACE), an intervention designed to improve care coordination, nurse education, and diabetes management in school. We conducted semistructured interviews with school nurses in two states. The interview guide was adapted from the Consolidated Framework for Implementation Research, which organizes determinants by the intervention, the individuals involved, the inner setting, (i.e., school district), the outer setting (i.e., external to the district), and the implementation processes. Major themes were summarized. We included 32 school nurses representing broad geographic regions, district sizes, and levels of nursing experience. School nurses reported that SPACE presented an advantage in care coordination compared with existing practice. Prominent barriers included (1) the intervention's complexity; (2) information sharing between schools and health systems; (3) high school nurses'caseloads, which may limit their availability; and (4) variable levels of parent engagement. Specific facilitators included (1) the intervention's adaptability and low cost, (2) high perceived need for interventions, (3) existing school resources that increase feasibility, (4) a focus on holistic outcomes which align with district priorities, and (5) relationships between school district nurses and leaders. Facilitators were perceived to be crucial to garnering buy-in from decision-makers within district leadership. The themes re-affirmed that school interventions for young people with type 1 diabetes are prioritized by school nurses. Implementation science frameworks can guide pre-implementation work and identify targets for implementation strategies which will mitigate barriers or leverage facilitators.

There is significant interest in antigen specific approaches both to delay type 1 diabetes in pre-clinical stages and after diagnosis to support tolerance. We conducted a Phase 1 trial of a non-integrating DNA plasmid constructed to secrete the type 1 diabetes antigen pre-proinsulin (PPI) and the immune modulatory cytokines transforming growth factor β1 (TGF-β1), interleukin-10 (IL-10), and interleukin-2 (IL-2). In this placebo controlled, double-masked study of 47 adults with stage 3 type 1 diabetes, we showed that the drug is safe and well tolerated, with most reported adverse events (AE) categorized as grade 1 and with no clinically significant difference in AE amongst treatment groups. There were no untoward metabolic or immune effects. We found pharmacodynamic evidence of treatment, as demonstrated by a dose dependent type 1 interferon (IFN) signature. Plasmid DNA, representing a pharmocokinetic measure, was detected in the two highest dosing groups. We did not find global or antigen-specific immune cell changes following treatment with a DNA plasmid expressing pre-proinsulin, IL-2, IL-10 and TGF-β1, nor did we detect IL-2, IL-10 or TGF-b1 driven immune changes. Our results support further trials of this novel tolerizing antigen construct.

OBJECTIVE Islet autoantibody positivity (AB+) has not been evaluated across different race, ethnicity, and socioeconomic deprivation categories in individuals at risk for type 1 diabetes. We examined data from TrialNet of persons screened for ABs and evaluated patterns by race and ethnicity and socioeconomic deprivation. RESEARCH DESIGN AND METHODS This analysis included 139,963 relatives of people with type 1 diabetes screened by TrialNet between 9 January 2012 and 31 December 2022. Race and ethnicity were categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic other. Home addresses were used to assign deprivation, ranging from least deprived (1) to most deprived (100), analyzed in quintiles. Descriptive and multivariate analyses assessed associations among race and ethnicity, deprivation, and AB+, adjusting for age and protocol period. RESULTS Single AB+ (SAB+) and multiple AB+ (MAB+) varied by age, race and ethnicity, and deprivation. Younger individuals had increased odds of MAB+ and decreased odds of SAB+. Non-Hispanic Black participants had significantly higher odds of AB+ (adjusted odds ratio 1.44 [95% CI 1.29, 1.62]), SAB+ (1.59 [1.38, 1.85]), and MAB+ (1.26 [1.06, 1.51]), while Hispanic individuals had higher odds of SAB+ (1.26 [1.15, 1.39]) and lower odds of MAB+ (0.81 [0.72, 0.91]) compared with non-Hispanic White individuals. Lowest deprivation was associated with higher odds of MAB+ (1.21 [1.06, 1.37]) but not SAB+. CONCLUSIONS AB+ patterns vary by race, ethnicity, and deprivation. Screening and prevention strategies should be designed to identify individuals at risk based on these factors to enable equitable risk stratification and access to diabetes preventive therapies.

BACKGROUND:Despite advances in treatments, children with type 1 diabetes struggle to achieve glycemic targets. Though school-based programs may help support families to achieve targets, challenges remain with coordinating care between health systems and schools, where students spend much of their day. Monthly, virtual meetings between a parent, school nurse, and a diabetes specialist may bridge this gap by using a shared treatment plan to meet goals. METHODS:This is a pilot cluster-randomized trial to test a school-partnered collaborative care model (SPACE for T1D) for children aged 5-12 years with type 1 diabetes for ≥6 months. School districts were randomized in a 2:1 allocation ratio to the intervention (SPACE for T1D) or enhanced usual care. Participants complete the study over four consecutive months. Parents and school nurses evaluate the feasibility, acceptability, appropriateness, and usability of SPACE using valid questionnaires. The study team monitors retention, fidelity, and practicality. Exploratory outcomes assess change in glycemia, care utilization, type 1 diabetes-related quality of life, self-efficacy skills, and missed class time due to diabetes interventions. RESULTS:Twelve school districts were randomized. One dropped out due to no eligible students, leaving 11 participating districts. We approached 46 students; 30 provided consent for a recruitment rate of 65%. CONCLUSIONS:This study will evaluate the feasibility and acceptability of the SPACE for T1D intervention in varied school districts. Findings will facilitate a fully-powered trial to evaluate the impact on health and academic outcomes, adding to the evidence base of school-based interventions to support youth with chronic disease. NCT: NCT06420661.

Introduction and Objective: EAs with T1D experience unique diabetes self-management challenges yet have alarmingly low DSMES participation. We assessed acceptability of a new DSMES program specifically designed for EAs. Methods: EAs with T1D, ages 18-26y, were recruited from pediatric and adult diabetes clinics (49 enrolled; 3 withdrew) to a DSMES program with 4 virtual, group-based sessions, lasting 30-45 minutes. Led by a diabetes care and education specialist, sessions centered on self-care behaviors within the context of issues salient to EAs, and used case studies to present content, engage EAs in discussion, and encourage application of knowledge/skills gained. Post-intervention, 34 participants completed interviews, which were analyzed to identify themes related to acceptability. Results: On average, EAs joined 3 out of 4 DSMES sessions with 65% (n=30/46) attending all 4 sessions. Most participants thought scheduling was easy, appreciating being offered flexible options; sessions were the right length or could be longer to offer more time for peer interaction; the ideal group size was 8-10 EAs; and the virtual format was convenient, but in-person might better support personal connections. Participants generally found topics relevant and liked the case studies, especially those with CGM examples. Participants strongly appreciated hearing from EAs at different stages of life/transfer of diabetes care. Interestingly, participants recruited from adult clinics reported wishing they had a program like this earlier in their transfer from pediatric to adult care. Ability to socialize with other EAs with T1D was reported to be both a key motivator to participate and one of the most important aspects of the program. Conclusion: Findings suggest EAs had an overall positive experience with this novel DSMES program and highlight a strong interest in peer interaction. A retrospective desire to have engaged in similar DSMES earlier underscores the need to further explore ways to connect with EAs early on. Disclosure J. Krall: Research Support; Current; Dexcom, Inc. L.M. Siminerio: None. M.E. Hamm: Research Support; Ended; Pfizer Inc. E. Hileman-Kaplan: None. C. Moon: None. J.M. Ng: Research Support; Ended; Sanofi-Aventis U.S. I. Libman: None. Funding National Institutes of Diabetes and Digestive and Kidney Diseases (5R34DK136020)

Introduction and Objective: PCP uptake of screening for T1D antibodies in those with a family history is recommended yet remains uncommon. Implementation science (IS) can help select and test strategies to promote screening in primary care. We conducted a pre-implementation assessment with PCPs to prioritize strategies for screening. Methods: We led site visits at 4 geographically diverse PCP offices (n=29 providers) in Western Pennsylvania. Providers participated in a facilitated discussion about facilitators/barriers to screening followed by a survey to rate IS strategies using a 1-5 Likert-type response (1=very unhelpful to 5=very helpful). Results: Facilitators included high perceived value of screening and similarities to existing screening practices in primary care. PCP concerns included (1) obtaining updated and accurate family history of T1D in well child care visits, (2) lack of resources to address positive screens, and (3) potential family costs/travel for screening/follow up care. Among 21 surveys, 5 strategies were highly prioritized with scores >4.5/5, focusing on electronic health record (EHR) templates, protocolized decision aids, and expert support (Table). Conclusion: Implementation trials should test the impact of combined strategies to promote uptake of T1D screening by PCPs, focusing on integrated clinical and EHR workflows and easy referral to pediatric endocrinology for staging/monitoring/interventions. Disclosure S. Orris: None. M. Ganoe: None. P.L. Schoemer: None. I. Libman: None. C. March: None. Funding UPMC Children's Hospital of Pittsburgh Foundation, Cochrane Weber Endowment

Introduction and Objective: Youth with type 1 diabetes (T1D) are at risk for early cardiometabolic dysfunction, yet practical clinical markers of physical fitness remain limited. We examined the association between relative muscle strength and central adiposity in youth with T1D. Methods: We conducted a cross-sectional study of youth with T1D (n=35). Handgrip strength was measured using a Jamar Smart Hand Dynamometer (three trials averaged) and normalized to body weight (kg/kg). Central adiposity was assessed using waist-to-height ratio (WHtR). Associations were evaluated using Pearson correlations and sex-adjusted linear regression. Results: Subjects were 18±2.3 years old, with diabetes duration of 8.6±4.7 years and BMI of 26±5.9 kg/m²; 69% male. Normalized handgrip strength was 0.51±0.16 kg/kg. Grip strength was negatively associated with WHtR (r=−0.65, p<0.001). After adjustment for age and sex, WHtR remained independently associated with normalized handgrip strength (β=−1.55, p<0.001). No associations were observed between grip strength and LDL-C, non-HDL-C, HbA1c, or CGM-derived metrics (p>0.05 for all). Results were similar when BMI replaced WHtR, whereas waist-to-hip ratio showed no association. Conclusion: In youth with T1D, central adiposity is independently associated with lower muscle strength, whereas traditional risk markers show no association. Simple functional measures may capture cardiometabolic risk not reflected by conventional metrics. Disclosure E. Tas: None. E. Gade: None. B. Moore: None. M. Tamilia: None. R. Muzumdar: None. A. Sekikawa: None. I. Libman: None. Funding Children's Hospital of Pittsburgh Foundation

Background Cardiovascular disease remains a major long-term complication of type 1 diabetes (T1D), with functional abnormalities emerging during childhood and adolescence. Traditional clinical markers, including blood pressure, lipids, body mass index, and glycemic indices, capture only part of cardiovascular risk and often fail to detect early autonomic, functional, or vascular changes. Objective To review emerging tools for early cardiovascular disease risk assessment in youth with T1D, focusing on functional capacity, autonomic regulation, vascular stiffness, and digital health–enabled monitoring. Methods In this narrative review, we summarize and synthesize evidence from observational studies, pediatric cohorts, and translational research evaluating submaximal functional testing, heart rate variability, ambulatory blood pressure monitoring, pulse wave velocity, and wearable technologies in youth with T1D. Emphasis is placed on physiologic relevance, feasibility in clinical settings, and limitations of current data. Clinical Implications Integrating functional, autonomic, and vascular assessments, interpreted using age- and sex-specific norms, longitudinal trends, and composite profiles, may enhance early identification of cardiovascular vulnerability in pediatric T1D. Key gaps include the need for pediatric reference standards, actionable thresholds, and prospective studies to determine whether these markers predict outcomes or respond to targeted interventions.

Objective: We compared long-term, real-world glycemic outcomes and device engagement in U.S. youth with type 1 diabetes (T1D) using two automated insulin delivery (AID) systems. Methods: We included youth (ages 6-18) with T1D from a large academic center who started on Insulet Omnipod 5 (OP5) or Tandem Control IQ (CIQ) between January 2020 and June 2024. We collected 30-day continuous glucose monitor and 30-day AID data at baseline and 3, 6, 12, and 18 months following AID initiation. We evaluated change in glycemic metrics and user behaviors (e.g., self-initiated bolusing and carbohydrate entry) by system using separate multivariable linear regression models at each time point while adjusting for baseline factors (age, sex, insulin regimen prior to AID initiation, diabetes duration, and baseline values for the respective glycemic metric). Results: All AID users (n = 722, median age 14.3 years, median diabetes duration 5.5 years, 83.9% previous pump users) had a significant change in time in range (TIR) across all time points (>9.9% increase). While CIQ users (n = 311) experienced a greater change in TIR at 3 and 6 months (+14.9% and +13.3%, respectively, vs. +10.0% and +10.2% among OP5 users), this difference waned with time (change in TIR at 18 months +9.9% with CIQ vs. +10.6% with OP5). Carbohydrate entry simultaneously decreased at the same intervals among CIQ users (199, 184, and 173 g at 3, 6, and 18 months, respectively) but not OP5 users (177, 184, and 181 g at 3, 6, and 18 months). Conclusions: Although glycemic outcomes are similar between devices over 18 months, AID user engagement changes with time and differs between systems, potentially as they "trust" their device more. Change in carbohydrate entry among CIQ users is likely a major contributor to the decline in TIR with longer duration of AID use.

BackgroundSchool-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. ObjectiveTo identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. MethodsWe recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. ResultsIn the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10%-60% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue (ρ=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. ConclusionsCross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing.

Since little is known about the disposition index (DI) in autoantibody-positive individuals, we have assessed whether DI has a similar association between insulin secretion and resistance to the association observed in other populations. In TrialNet Pathway to Prevention (TNPTP; n=6620) and Diabetes Prevention Trial-Type 1 (DPT-1; n=704) study participants, two secretion-sensitivity pairs each representing a DI were analyzed cross-sectionally at baseline: AUC C-peptide/AUC glucose (AUC Ratio) and Matsuda Index (MI) from TNPTP OGTTs (oral DI), first-phase insulin response (FPIR) and 1/fasting insulin (1/FI) from DPT-1 from IVGTTs (DI). Participants were followed for progression to type 1 diabetes. Within the normal and diabetes glucose ranges, associations of AUC ratio with MI in TNPTP, and FPIR with 1/FI in DPT-1, had inverse curvilinear patterns with convexities to the origin. After logarithmic transformations to linearize the secretion and sensitivity measures, the inverse slope was steeper for the diabetes range (p<0.0001). In a Cox regression model including the AUC Ratio and MI as variables and another model including FPIR and 1/FI, the interaction terms of secretion x sensitivity (i.e., the DI/ODI), predicted stage 3 type 1 diabetes in both (p<0.0001). The DI remained significantly predictive (p<0.0001) when the DPT-1 risk score was added as a covariate in regression models. In autoantibody-positive populations, insulin secretion is inversely related to sensitivity in a quasi-hyperbolic relationship in normal and diabetes ranges of glucose. The DI can be represented by a statistical and physiologic interaction between secretion and sensitivity that is predictive of stage 3 type 1 diabetes.

Type 1 diabetes has been redefined to include pre-symptomatic stages prior to clinical disease.1 Screening for islet autoantibodies is recommended in those with a known family history or elevated genetic risk to enable access to interventions and reduce diabetic ketoacidosis (DKA) at diagnosis.2 For those with positive antibodies, consensus guidance recommends monitoring for dysglycemia at regular intervals based on age and antibody number.3 Screening is generally supported by pediatric and adult endocrinologists, though chronically understaffed clinics may limit implementation.4 The guidance advocates that primary care providers (PCPs) participate in screening and monitoring.3 Though PCPs have identified priorities for type 1 diabetes screening tests,5 little is known about their understanding and capacity to engage in screening and monitoring, an essential first step prior to implementing widescale programs.