ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This is the first International Consensus Guidance on the monitoring of children, adolescents and adults with early-stage (pre-symptomatic) Type 1 Diabetes (T1D), defined as those individuals positive for islet autoantibodies and with either normoglycemia or dysglycemia.

With the progressive increase in screening programs for T1D around the world, there is a growing number of individuals identified with early-stages pre-symptomatic T1D (1). The detection of islet autoantibodies is currently the earliest indicator of future clinical T1D risk (2). Many individuals with positive T1D autoantibodies are offered monitoring through research studies and might be enrolled into intervention trials. However, not all individuals wish to or can participate in research. Still, they should be offered some form of follow-up to diagnose early on stage 3 T1D (symptomatic T1D) before onset of diabetic ketoacidosis (DKA) and to enable better long-term outcomes.

This landmark consensus guidance was developed by Breakthrough T1D (formerly known as JDRF) in partnership with several diabetes and endocrine societies and experts from several countries. It is designed for non-specialists, primary care providers, and pediatricians, as these are most likely to care for individuals who test positive for T1D autoantibodies. The guidance stresses that a partnership should be established between endocrinologists and primary care providers to care for these individuals. Key points are: 1) a positive screen with one or more T1D autoantibody should be confirmed by testing a second sample, to exclude false positive results; 2) those with confirmed early-stage T1D should have periodic medical monitoring, including 3-6 monthly glucose testing, regular education about symptoms of diabetes and DKA, and psychosocial support; 3) monitoring should be personalised based on age, number of autoantibodies and T1D stage (stage 1: normoglycemia; stage 2: dysglycemia); 4) people with pre-symptomatic T1D should be offered trial participation or approved immunotherapies, where available. Of note, the guidance outlines the importance of psychosocial and educational support for individuals and families and how this should be provided.

This guidance represents a key milestone in the field of T1D. It will help clinicians support the increasing numbers of children and young people being identified in early stages of T1D through general population screening or clinical practice.

References: 1. Simmons KM, Sims EK. Screening and Prevention of Type 1 Diabetes: Where Are We? J Clin Endocrinol Metab. 2023;108(12):3067-79.2. Ziegler AG, Rewers M, Simell O, Simell T, Lempainen J, Steck A, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. Jama. 2013;309(23):2473-9.