Consensus Report|June 24 2024
Åke Lernmark, Moshe Philip, Tadej Battelino, Thomas Danne m fl
Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes
Given 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 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 for (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 nonspecialized 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 emphasizes significant unmet needs for further research on early-stage type 1 diabetes to increase the rigor of future recommendations and inform clinical care
This article contains supplementary material online at https://doi.org/10.2337/figshare.25800055.
This consensus report was endorsed by the European Society for the Study of Diabetes (EASD), American Diabetes Association (ADA), American Association of Clinical Endocrinology (AACE), American College of Diabetology (ACD), Association of Diabetes Care & Education Specialists (ADCES), Australian Diabetes Society (ADS), the International Society for Pediatric and Adolescent Diabetes (ISPAD), Advanced Technologies & Treatments for Diabetes (ATTD), DiaUnion, the Endocrine Society, and JDRF International.
This article is being simultaneously published in Diabetes Care
https://doi.org/10.2337/dci24-0042) and
Diabetologia
https://doi.org/10.1007/s00125-024-06205-5) by the ADA and the EASD.
A consensus report is a document on a particular topic that is authored by a technical expert panel under the auspices of ADA. The document does not reflect the official ADA position but rather represents the panel’s collective analysis, evaluation, and expert opinion.
The primary objective of a consensus report is to provide clarity and insight on a medical or scientific matter related to diabetes for which the evidence is contradictory, emerging, or incomplete. The report also aims to highlight evidence gaps and to propose avenues for future research. Consensus reports undergo a formal review process, including external peer review and review by the ADA Professional Practice Committee and ADA scientific team for publication.
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