Abstract body	Background
Diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) is a preventable life-threatening complication with potential long-term sequelae. Decreased DKA prevalence has been reported in children screened for islet autoantibodies and followed with education regarding symptoms of diabetes. 

Aim
The aim of this study was to assess the impact of a research screening on a frequency of DKA at diagnosis.
Method
The study population included 3439 children for whom DKA status was known, out of the 3544 diagnosed with T1D before age 18, in Colorado, in 1998–2012. Of those, 133 children or 4% had participated in a study that screened for islet autoantibodies: Diabetes Autoimmunity Study in the Young, Type 1 Diabetes TrialNet, or The Environmental Determinants of Diabetes in the Young. Insurance status at diagnosis was categorized into private, government-provided or none. The impact of a research screening available in a defined population for 12 years, on DKA at diagnosis, was estimated controlling for demographic factors, health insurance and T1D family history.
Results
DKA was present in 1339 of the youth at T1D diagnosis (38.9%; 95% CI 37.3-40.6%). Among those previously screened for islet autoantibodies, only 9 (6.8%) had DKA while 52 would be expected. In multiple logistic regression controlling for age, sex, ethnicity and health insurance, prior participation in a research screening for islet autoantibodies had a powerful protective effect on DKA at diagnosis -OR = 0.2 (95%CI 0.2-0.4), independent of T1D in a 1st degree (0.4; 0.3-0.5) or 2nd degree relative (0.6; 0.5-0.8).
Discussion
Participation in research studies that screen children for islet autoantibodies and educate regarding symptoms of diabetes and home glucose monitoring during child’s illness can prevent ~80% of DKA. The existing technology is sufficient to consider a widespread screening of all children for islet autoantibodies and intensive follow-up of those positive, as one of the approaches to prevention of DKA.

Effect of screening for islet autoantibodies on diabetic ketoacidosis at diagnosis of type 1 diabetes in children