Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes

著者: Moshe Phillip, Peter Achenbach, Ananta Addala, Anastasia Albanese-O’Neill, Tadej Battelino, Kirstine J. Bell, Rachel Besser, Ezio Bonifacio, Helen M. Colhoun, Jennifer Couper, Maria E. Craig, Thomas Danne, Carine de Beaufort, Klemen Dovč, Kimberly A. Driscoll, Sanjoy Dutta, Osagie Ebekozien, Helena Elding Larsson, Daniel J. Feiten, Brigitte I. Frohnert, Robert A. Gabbay, Mary Gallagher, Carla J. Greenbaum, Kurt Griffin, William Hagopian, Michael J. Haller, Christel Hendrieckx, Emile Hendriks, Richard I. G. Holt, Lucille Hughes, Heba M. Ismail, Laura M. Jacobsen, Suzanne Bennett Johnson, Leslie E. Kolb, Olga Kordonouri, Karin Lange, Robert W. Lash, Åke Lernmark, Ingrid Libman, Markus Lundgren, David M. Maahs, M. Loredana Marcovecchio, Chantal Mathieu, Kellee M. Miller, Holly K. O’Donnell, Tal Oron, Shivajirao P. Patil, Rodica Pop‐Busui, Marian Rewers, Stephen S. Rich, Desmond Schatz, Rifka Schulman‐Rosenbaum, Kimber M. Simmons, Emily K. Sims, Jay S. Skyler, Laura Smith, Cate Speake, Andrea K. Steck, Nicholas Thomas, Ksenia N. Tonyushkina, Riitta Veijola, John M. Wentworth, Diane K. Wherrett, Jamie Wood, Anette‐Gabriele Ziegler, Linda A. DiMeglio - Diabetologia 2024 被引用: 58

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. Graphical Abstract