Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes
Authors: Phillip Moshe , Achenbach Peter , Addala Ananta , Albanese-O’Neill Anastasia , Battelino Tadej , Bell Kirstine J. , Besser Rachel E.J. , Bonifacio Ezio , Colhoun Helen M. , Couper Jennifer J. , Craig Maria E. , Danne Thomas , de Beaufort Carine , Dovc Klemen , Driscoll Kimberly A. , Dutta Sanjoy , Ebekozien Osagie , Elding Larsson Helena , Feiten Daniel J. , Frohnert Brigitte I. , Gabbay Robert A. , Gallagher Mary P. , Greenbaum Carla J. , Griffin Kurt J. , Hagopian William , Haller Michael J. , Hendrieckx Christel , Hendriks Emile , Holt Richard I.G. , Hughes Lucille , Ismail Heba M. , Jacobsen Laura M. , Johnson Suzanne B. , Kolb Leslie E. , Kordonouri Olga , Lange Karin , Lash Robert W. , Lernmark Åke , Libman Ingrid , Lundgren Markus , Maahs David M. , Marcovecchio M. Loredana , Mathieu Chantal , Miller Kellee M. , O’Donnell Holly K. , Oron Tal , Patil Shivajirao P. , Pop-Busui Rodica , Rewers Marian J. , Rich Stephen S. , Schatz Desmond A. , Schulman-Rosenbaum Rifka , Simmons Kimber M. , Sims Emily K. , Skyler Jay S. , Smith Laura B. , Speake Cate , Steck Andrea K. , Thomas Nicholas P.B. , Tonyushkina Ksenia N. , Veijola Riitta , Wentworth John M. , Wherrett Diane K. , Wood Jamie R. , Ziegler Anette-Gabriele , DiMeglio Linda A. 
Published: June 2024

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.