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Consensus guidance for monitoring persons with islet autoantibody-positive pre-Stage 3 type 1 diabetes

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posted on 2024-06-24, 00:10 authored by Moshe Phillip, Peter Achenbach, Ananta Addala, Anastasia Albanese-O'Neill, Tadej Battelino, Kirstine J Bell, Rachel E J Besser, Ezio Bonifacio, Helen M Colhoun, Jennifer J Couper, Maria E Craig, Thomas Danne, Carine de Beaufort, Klemen Dovc, Kimberly A Driscoll, Sanjoy Dutta, Osagie Ebekozien, Helena Elding Larsson, Daniel J Feiten, Brigitte I Frohnert, Robert A Gabbay, Mary Pat Gallagher, Carla J Greenbaum, Kurt J Griffin, William Hagopian, Michael J Haller, Christel Hendrieckx, Emile Hendriks, Richard I G Holt, Lucille Hughes, Heba M Ismail, Laura M Jacobsen, Suzanne B Johnson, Leslie E Kolb, Olga Kordonouri, Karin Lange, Robert W Lash, Åke Lernmark, Ingrid Libman, Markus Lundgren, David M Maahs, M Loredana Marcovecchio, Chantal Mathieu, Kellee M Miller, Holly K O'Donnell, Tal Oron, Shivajirao P Patil, Rodica Pop-Busui, Marian J Rewers, Stephen S Rich, Desmond A Schatz, Rifka Schulman-Rosenbaum, Kimber M Simmons, Emily K Sims, Jay S Skyler, Laura B Smith, Cate Speake, Andrea K Steck, Nicholas BP Thomas, Ksenia N Tonyushkina, Riitta Veijola, John M Wentworth, Diane K Wherrett, Jamie R Wood, Anette-Gabriele Ziegler, Linda A DiMeglio

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes (T1D) diagnosis and emerging availability of therapy to delay disease progression, T1D screening programs are being increasingly emphasized. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody positive (IAb⁺) children and adults who are at risk of (confirmed single IAb⁺) or living with (multiple IAb⁺) early-stage (stage 1 and stage 2) T1D. These individuals will need monitoring for disease progression; much of this care will happen in non-specialized settings. To inform this monitoring, the JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes: 1) Partnerships should be fostered between endocrinologists and primary care providers to care for persons with IAb. 2) When persons who are IAb⁺are initially identified there is a need for confirmation on a second sample. 3) Single IAb⁺ individuals are at lower risk of progression than multiple IAb⁺ individuals. 4) Individuals with early-stage T1D should have periodic medical monitoring, including regular assessments of glycemia, regular education about symptoms of diabetes and DKA, and psychosocial support. 5) Interested persons with stage 2 T1D should be offered trial participation or approved therapies. 6) All health professionals involved in monitoring and care of individuals with T1D have a responsibility to provide education. The guidance also emphasizes significant unmet needs for further research on early-stage T1D to increase the rigor of future recommendations and inform clinical care.