ASK (Autoimmunity Screening for Kids)

What ASK screens for

Autoimmunity Screening for Kids (ASK) is a general-population program run by the Barbara Davis Center for Diabetes at the University of Colorado that tests children for the islet autoantibodies marking the immune attack behind type 1 diabetes (T1D) — and, in the same sample, for celiac disease.¹ Its defining choice is who it tests: every child, regardless of family history, rather than only relatives of people who already have T1D.²

A single blood sample is run on a high-throughput multiplex electrochemiluminescence (ECL) assay that measures all four islet autoantibodies — to insulin, GAD65, IA-2, and zinc transporter 8 (ZnT8) — in one well, alongside the celiac (transglutaminase) marker.¹ Positives are confirmed and, where needed, cross-checked against the older radio-binding assay (RBA).³ The ECL platform was adopted as ASK's primary tool precisely because it is more disease-specific: in screening, most single-antibody RBA positives are low-affinity and don't predict diabetes, whereas the ECL assay agreed with RBA in 95% of children who went on to develop T1D while flagging far fewer of the low-risk single positives.¹ That matters for a program testing healthy children — it keeps false alarms down.

The 1/2/3 staging model

A positive result is interpreted through the consensus staging of presymptomatic T1D.⁴ Stage 1 is two or more islet autoantibodies with normal blood sugar; stage 2 is two or more antibodies plus dysglycemia (abnormal glucose, still no symptoms); stage 3 is clinical disease.⁴ Crossing into stage 1 confers very high lifetime risk: in the comparable German Fr1da program, multiple-autoantibody children had a roughly 25% risk of clinical diabetes within just three years.⁵ Children with a single antibody are monitored rather than treated, since their risk is lower and slower.⁴

Why early detection matters

Finding T1D before symptoms is what prevents the dangerous crisis of diabetic ketoacidosis (DKA) at diagnosis. In Fr1da, among 280 screen-detected children, only two presented in DKA — a dramatic contrast with the roughly 20-40% who arrive in DKA when T1D is a surprise.⁵ Population screening reduces DKA at onset by around half or more, which is the central health benefit driving its economics.² Early detection also opens the door to monitoring, clinical trials, and — for staged candidates — therapy.

Reach and cost

Reach is the whole point. Only about 10-15% of new T1D occurs in people with an affected first-degree relative, so screening limited to relatives misses most future cases; general-population screening is the only way to find the rest.² ASK began in metropolitan Denver and has screened tens of thousands of children, with costs of roughly $4,700 per case detected in the program (versus about $14,000 modeled for routine clinical screening).⁶ More broadly, early T1D or celiac disease can be detected at a low per-child cost — cheaper than existing newborn screening panels — and analyses conclude the investment is justified when it cuts DKA and improves long-term glucose control.²

What's coming

ASK's near-term trajectory is from research program to public-health service: free testing is now offered to children across the U.S. via mail-in sampling, with national-scale modeling estimating hundreds of thousands of U.S. children are already in stage 1 or 2 today.² The downstream payoff has also grown sharper — teplizumab (Tzield), an anti-CD3 therapy, delays progression from stage 2 to stage 3 by a median of about two years and is now FDA-approved down to age 1, making screening's "find them early" promise directly actionable.⁷⁸ The remaining gaps are reimbursement, integration into routine pediatric care, and lower-burden home collection.

References

1. He L, Jia X, Geno Rasmussen C, et al. High-Throughput Multiplex Electrochemiluminescence Assay Applicable to General Population Screening for Type 1 Diabetes and Celiac Disease. Diabetes Technology & Therapeutics (2022). https://pmc.ncbi.nlm.nih.gov/articles/PMC9464081/ ↩ ↩² ↩³

2. Rewers M. Health economic considerations of screening for early type 1 diabetes. Diabetes, Obesity & Metabolism (2025). https://pmc.ncbi.nlm.nih.gov/articles/PMC12312819/ ↩ ↩² ↩³ ↩⁴ ↩⁵

3. Stahl MG, Geno Rasmussen C, Dong F, et al. Mass Screening for Celiac Disease: The Autoimmunity Screening for Kids Study. American Journal of Gastroenterology (2021). https://pmc.ncbi.nlm.nih.gov/articles/PMC7775339/ ↩

4. Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care (2015). https://pmc.ncbi.nlm.nih.gov/articles/PMC5321245/ ↩ ↩² ↩³

5. Ziegler AG, Kick K, Bonifacio E, et al. Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany. JAMA (2020). https://pmc.ncbi.nlm.nih.gov/articles/PMC6990943/ ↩ ↩²

6. McQueen RB, Geno Rasmussen C, Waugh K, et al. Cost and Cost-effectiveness of Large-scale Screening for Type 1 Diabetes in Colorado. Diabetes Care (2020). https://pmc.ncbi.nlm.nih.gov/articles/PMC7305000/ ↩

7. Herold KC, Bundy BN, Long SA, et al. An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes. New England Journal of Medicine (2019). https://pmc.ncbi.nlm.nih.gov/articles/PMC6776726/ ↩

8. U.S. Food and Drug Administration. TZIELD (teplizumab-mzwv) prescribing information. FDA (2026 label; stage-2 delay indication in adults and pediatric patients 1 year and older). https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/761183s013lbl.pdf ↩