Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes
International consensus (ADA-endorsed) · 2024 · international
Source and licence
- Authors
- Moshe Phillip, Peter Achenbach, Ananta Addala et al.
- Title
- Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes
- Journal
- Diabetologia, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11410955
Licence statement of the original publication
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Recommendations
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Abstract
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.
Supplementary Information: The online version contains peer-reviewed but unedited supplementary material including a slideset of the figures for download, available at 10.1007/s00125-024-06205-5.
Contents of the original publication
The section headings of the original.
- Overview
- Introduction and rationale
- The requirement for monitoring
- Objectives and methodology
- Methodology
- 1. Terminology
- 2. Partnership between primary-care and specialist HCPs
- 3. Monitoring in children and adolescents
- The current landscape of monitoring children and adolescents in early-stage type 1 diabetes
- Monitoring for single IAb+ at-risk children
- Monitoring for multiple autoantibody-positive children (early-stage type 1 diabetes)
- 4. Monitoring in adults
- The current landscape of monitoring adults who are at risk of or have early-stage type 1 diabetes
- Monitoring for single autoantibody-positive at-risk adults
- Monitoring for multiple autoantibody-positive adults (early-stage type 1 diabetes)
- Monitoring during pregnancy for IAb+ women
- 5. When to start insulin
- 6. Education
- When should education be provided?
- Key education topics
- Educational topics of highest value for IAb+ individuals and family members
- Where should education be provided?
- Who should provide education?
- 7. Psychosocial support
- What is the current landscape regarding psychosocial support for people with type 1 diabetes-related autoantibodies?
- What is the purpose of psychosocial support?
- What type of support should be provided?
- 8. Unmet needs for further research
- Authors’ relationships and activities
- Contribution statement
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