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 , Larsson Helena Elding , 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 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