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. 2024 Jul 9:17:3003-3014.
doi: 10.2147/IJGM.S438009. eCollection 2024.

Recommendations for Screening and Monitoring the Stages of Type 1 Diabetes in the Immune Therapy Era

Daniel J Moore  1 , Natasha I Leibel  2 , William Polonsky  3 , Henry Rodriguez  4
Affiliations

Recommendations for Screening and Monitoring the Stages of Type 1 Diabetes in the Immune Therapy Era

Daniel J Moore et al. Int J Gen Med. .

Abstract

Type 1 diabetes (T1D) is a complex, chronic autoimmune disease that affects over 1.6 million people in the United States. It is now understood that T1D may be undetected for many years while the disease progresses quietly without producing symptoms. T1D can be identified through diabetes-related autoantibody screening and staged accordingly, enabling healthcare providers to identify high-risk individuals in the early stages of the disease and either provide a stage-specific intervention or offer clinical trial opportunities to preserve beta cell function and anticipate the onset of clinical T1D. Evidence-based clinical practice guidelines currently do not exist for routine diabetes-related autoantibody screening of individuals at risk of developing T1D or of the general population. The purpose of this article is to help clinicians acquire an understanding of the rationale and protocols recommended for identifying patients at risk of developing T1D and monitoring such patients for autoimmune markers and progression of disease from Stage 1 to Stage 3 (clinical disease).

Keywords: Type 1 Diabetes; autoantibodies; immunotherapy; screening.

Plain language summary

Type 1 diabetes (T1D) is a life-long condition where the body’s immune system (which normally fights infection) mistakenly attacks cells in the pancreas that make insulin. Insulin allows one to use energy from food and controls blood sugar levels. Without early recognition and treatment, high blood sugar can cause serious symptoms and life-threatening complications, such as diabetic ketoacidosis (DKA). DKA happens when there is very low insulin, and if not spotted early, it can cause coma and death. T1D can occur at any age. The chance of getting T1D is higher if another family member has it. T1D progresses silently for months or years before symptoms appear such as increased thirst, frequent urination, and unintentional weight loss. Healthcare providers can now screen and identify people who are at early stages of T1D (without symptoms) with blood tests called autoantibodies. Early detection through screening allows people to 1) learn about the disease before symptoms start and insulin is needed, 2) potentially receive treatments that delay T1D progression, and 3) participate in research trials. By detecting T1D at early stages, people can connect with the right care team and develop the skills needed to manage later stage T1D. Early detection has been shown to prevent hospitalization and life-threatening conditions. Screening for T1D will help people maximize their opportunities to delay T1D onset while preparing for diabetes care.

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Conflict of interest statement

DM is a consultant for Provention Bio. NL is a consultant for Sanofi. WP reports research support from Abbot and Dexcom; is a consultant for Bigfoot, Eli Lilly, Embecta, Mankind, Novo Nordisk, Provention Bio and Sanofi. HR reports research support from Dexcom, Eli Lilly, MannKind, Medtronic, Novo Nordisk, and Provention Bio; serves on an advisory board for Provention Bio; serves on a Data and Safety Monitoring Board for Merck and Provention Bio; participated in Speaker’s Bureau for Provention Bio. He also reports personal fees from Sanofi for Disease State Presentations DSMB and TrialNet & EDIC funding from NIH, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

None
Graphical abstract
Figure 1
Figure 1
Stages of Type 1 Diabetes Progression.,, Adapted with permission from https://www.trialnet.org/t1d-facts. aEffective October 1, 2024.
Figure 2
Figure 2
(A) Pathways for Screening, Monitoring and Treatment.,,,,, (B) Glycemic Monitoring and Treatment Options.,,,
See this image and copyright information in PMC

References

    1. Powers AC. Type 1 diabetes mellitus: much progress, many opportunities. J Clin Invest. 2021;131(8):e142242. doi:10.1172/JCI142242 - DOI - PMC - PubMed
    1. Greenbaum CJ. A key to T1D prevention: screening and monitoring relatives as part of clinical care. Diabetes. 2021;70(5):1029–1037. doi:10.2337/db20-1112 - DOI - PMC - PubMed
    1. Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026–2044. doi:10.2337/dci18-0023 - DOI - PMC - PubMed
    1. James MM. TZIELD Injection, for Intravenous Use [Prescribing Information]. Red Bank, NJ: Provention Bio, Inc.; 2022.
    1. Gregory GA, Robinson TIG, Linklater SE, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022;10(10):741–760. doi:10.1016/S2213-8587(22)00218-2 - DOI - PubMed

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