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Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes
journal contribution
posted on 2024-07-04, 05:35 authored by Moshe Phillip, Peter Achenbach, Ananta Addala, Anastasia Albanese-O’Neill, Tadej Battelino, Kirstine J Bell, Rachel EJ 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 P Gallagher, Carla J Greenbaum, Kurt J Griffin, William Hagopian, Michael J Haller, Christel HendrieckxChristel Hendrieckx, Emile Hendriks, Richard IG 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 PB Thomas, Ksenia N Tonyushkina, Riitta Veijola, John M Wentworth, Diane K Wherrett, Jamie R Wood, Anette-Gabriele Ziegler, Linda A DiMeglioAbstractGiven the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. 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) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb+; (2) when people who are IAb+ are initially identified there is a need for confirmation using a second sample; (3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care.
Graphical Abstract
