Co-published in Diabetes Care and Diabetologia, the first international type 1 diabetes monitoring consensus delineates clear guidance for healthcare professionals to track and treat people who test positive for diabetes autoantibodies
Guidance was convened by Breakthrough T1D and developed in partnership with the Advanced Technologies & Treatments for Diabetes (ATTD), the American Association of Clinical Endocrinology (AACE), the American Diabetes Association (ADA), the Association of Diabetes Care & Education Specialists (ADCES), the Endocrine Society, the Australian Diabetes Society (ADS), the European Association for the Study of Diabetes (EASD), the International Society for Pediatric and Adolescent Diabetes (ISPAD), and 60 experts from 11 countries on 4 continents
New York, June 24, 2024 – Breakthrough T1D (formerly JDRF), the leading global type 1 diabetes (T1D) research and advocacy organization, together with international diabetes experts from around the world, today announced the development of the first international consensus guidance titled “Consensus Guidance for Monitoring Persons with Islet Autoantibody-Positive Pre-Stage 3 Type 1 Diabetes,” for monitoring people who test positive for one or more islet autoantibody, putting them at risk of developing T1D. The consensus guidance was published today online ahead of print in Diabetes Care and Diabetologia and released today during the American Diabetes Association’s 84th Scientific Sessions in Orlando, Florida.
The detection of autoantibodies is currently the earliest indicator that an individual may develop T1D in their lifetime. The guidance – designed for non-specialists, primary care providers, and pediatricians who are most likely to care for individuals who test positive – defines how these patients should be monitored. Studies show that monitoring following T1D screening can significantly reduce the incidence of diabetes-related ketoacidosis (DKA) at diagnosis and allows those in early stages of T1D to receive disease management guidance, potentially delay the onset through disease-modifying therapy, and/or to enroll in clinical trials assessing effectiveness of novel therapies.1
“Depending on where they live, up to 70% of people with T1D experience DKA at diagnosis, underscoring the importance of screening and clear and concise monitoring guidance,” said Anastasia Albanese-O’Neill, PhD, AVP of Community Screening and Clinical Trial Education, Breakthrough T1D. “Early detection and T1D monitoring are key priority areas for Breakthrough T1D as we drive toward cures and continue to advance therapies that can change the course of T1D for those who face it. We recognized that there was a clinical gap following T1D screening, so we led the charge to convene a panel to develop monitoring guidance that would address this need,” she said. “It is a monumental achievement to have consensus among leading international experts in T1D for monitoring people of all ages. It is vital that we continue to build momentum toward a future without T1D by investing in ongoing research and encouraging expanded access and participation in screening. The time is now.”
Screening for T1D autoantibodies is not yet commonplace, although research has shown that T1D can be detected before the presence of symptoms or clinical diagnosis, and there is increasing consensus and evidence that those with a family history of T1D should be screened. The new expert clinical advice underscores the importance of accurately diagnosing the current stage of T1D and providing ongoing monitoring for disease progression that is tailored to the needs of the affected individuals and their families. Additionally, for the first time, the guidance outlines how to provide psychosocial and educational support for individuals and families.
Knowing one’s autoantibody status through screening provides an opportunity to enroll in research studies that help advance the science to identify factors that could delay and ultimately prevent T1D. Research plays a crucial role in understanding the underlying mechanisms of T1D development, including the role of genetics, autoimmunity, and environmental factors. This understanding is essential for the development of effective prevention strategies and disease-modifying therapies.
“More people at risk of T1D need to be screened, and for those who test positive, we now have a clearer path to delaying the onset of diabetes or preventing complications like ketoacidosis,” said Moshe Phillip, MD, Chair of the Consensus Monitoring Guidance and Director, Institute for Endocrinology and Diabetes at the National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, and Faculty of Medicine, Tel Aviv University, Israel. “The new guidance should encourage more primary care providers to offer screening to their patients – especially those with a family history of T1D – so we can identify those at risk earlier and improve outcomes for those who go on to develop T1D.”
Primary care providers – who are experienced in screening for a variety of conditions – play a key role in screening and early-stage monitoring of children and adults who are positive for T1D autoantibodies. Education programs could help more primary care providers learn staging criteria, which are still relatively new and not yet widely known. As some individuals progress to T1D rapidly and others may take decades to develop symptoms, monitoring recommendations vary, and primary care providers can partner with specialists when care needs shift over time.
“Preventing, optimizing management, and finding cures for T1D will require commitment and actions by multiple healthcare partners, including primary care providers, specialists, and healthcare educators,” said Linda A DiMeglio, MD, MPH Vice-Chair of the Consensus Monitoring Guidance Working Group and Division Chief for Pediatric Endocrinology and Diabetology in the Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana. “Providing these partners with evidence-based guidance for early-stage monitoring and management for individuals identified with islet autoantibodies is an important step forward toward improved outcomes.”
The consensus process was initiated by Breakthrough T1D during the 16th International Conference on Advanced Technologies & Treatments for Diabetes in Berlin, Germany. The initial working group included 61 internationally recognized experts in early-stage T1D diagnosis and care. In the coming weeks, Breakthrough T1D will launch a public education campaign to encourage more people to talk to their doctors about T1D screening. Screening can help identify early-stage T1D before symptoms occur so that a monitoring plan can be developed with your healthcare provider. For more information on early T1D screening and detection, visit: https://www.breakthrought1d.org/early-detection/.
About Breakthrough T1D, Formerly JDRF
As the leading global type 1 diabetes research and advocacy organization, Breakthrough T1D helps make everyday life with type 1 diabetes better while driving toward cures. We do this by investing in the most promising research, advocating for progress by working with government to address issues that impact the T1D community, and helping educate and empower individuals facing this condition.
About Type 1 Diabetes (T1D)
T1D is an autoimmune condition that causes the pancreas to make very little insulin or none at all. This leads to dependence on insulin therapy and the risk of short and long-term complications, which can include highs and lows in blood sugar; damage to the kidneys, eyes, nerves, and heart; and even death. Globally, it impacts nearly 9 million people. Many believe T1D is only diagnosed in childhood and adolescence, but diagnosis in adulthood is common and accounts for nearly 50% of all T1D diagnoses. The onset of T1D has nothing to do with diet or lifestyle. While its causes are not yet entirely understood, scientists believe that both genetic factors and environmental triggers are involved. There is currently no cure for T1D.
Reference
- Besser REJ, Bell KJ, Couper JJ, Ziegler A, Wherrett DK, Knip M, et al. ISPAD clinical practice consensus guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1175-87.
