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Review
. 2025 Jun 24;25(1):38.
doi: 10.1007/s11892-025-01595-1.

From Prediction to Prevention: The Intricacies of Islet Autoantibodies in Type 1 Diabetes

Aye Khine  1   2 , Zoe Quandt  3   4
Affiliations
Review

From Prediction to Prevention: The Intricacies of Islet Autoantibodies in Type 1 Diabetes

Aye Khine et al. Curr Diab Rep. .

Abstract

Purpose of review: This review synthesizes current knowledge on islet autoantibodies (IAs) as predictive biomarkers for type 1 diabetes (T1D), focusing on their role in disease staging, autoantibody patterns, advancements in screening methodologies, and the implications of implementing population-wide screening initiatives.

Recent findings: Autoantibody profiling has refined T1D risk stratification, with progression rates influenced by IA characteristics including number, type, order of appearance, and affinity. While screening efforts initially targeted genetically at-risk groups, approximately 90% of new TID diagnoses occur in individuals without a family history, underscoring the need for broader population-based screening. The approval of teplizumab, a therapy shown to delay clinical T1D onset, represents a paradigm shift by providing an intervention following early identification through screening. Technological advancements have further optimized IA detection and therapeutic strategies. However, challenges such as cost-effectiveness, implementation logistics, and assay standardization remain. T1D is a chronic autoimmune disorder characterized by progressive pancreatic beta-cell destruction, leading to insulin deficiency. The natural history of T1D is typically marked by the appearance of IAs long before clinical symptoms emerge, providing a window for early detection and intervention. Identifying at-risk individuals during this asymptomatic phase can reduce disease severity at clinical onset and facilitate timely application of disease-modifying therapies like teplizumab. Emerging evidence emphasizes that IA characteristics collectively shape disease risk and progression. Advancements in screening technologies and therapies continue to support the integration of IA screening into clinical care, marking a significant step toward effective T1D prevention and management.

Keywords: Autoantibodies; Screening; Type 1 diabetes.

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Conflict of interest statement

Declarations. Z.Q. has acted as a scientific advisor to Sanofi for a scientific advisory board in November 2023. Competing interests : ZQ has previously been on a scientific advisory board for Sanofi. Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Human and Animal Rights and Informed Consent : This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Schematic of T1D progression from genetic susceptibility to clinical diagnosis, overlaid with the features of pancreatic beta-cell destruction and islet autoantibody (IA) appearance. It highlights key IAs implicated in T1D, including insulin autoantibody (IAA), glutamic acid decarboxylase antibody (GADA), islet-antigen-2 antibody (IA-2A, IC-512), and zinc transporter 8 antibody (ZnT8A). The beta-cell graphic visually represents the autoimmune changes that are thought to occur during the immune response phase and early stages of T1D. Abbreviations: IAA (insulin autoantibody), GADA (glutamic acid decarboxylase antibody), IA-2A/IC-512 (islet-antigen-2 antibody), ZnT8A (zinc transporter 8 antibody). Modified from The Stages of Type 1 Diabetes by Type1Strong (https://www.type1strong.org/blog-post/the-stages-of-type-1-diabetes) and created in https://BioRender.com
Fig. 2
Fig. 2
Key components and considerations for implementation of T1D general population screening. Created in https://BioRender.com
See this image and copyright information in PMC

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