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Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

Hendriks, A. Emile J. ; Marcovecchio, M. Loredana ; Besser, Rachel E.J. ; Bonifacio, Ezio ; Casteels, Kristina ; Elding Larsson, Helena LU orcid ; Gemulla, Gita ; Lundgren, Markus LU ; Kordonouri, Olga and Mallone, Roberto , et al. (2024) In Diabetes/Metabolism Research and Reviews 40(2).
Abstract

Background/Aim: Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. Methods: Expert consensus was obtained from members of the Fr1da, GPPAD,... (More)

Background/Aim: Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. Methods: Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies. Results: The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented. Conclusions: As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
monitoring, presymptomatic type 1 diabetes, primary care, screening, specialist care, staging
in
Diabetes/Metabolism Research and Reviews
volume
40
issue
2
article number
e3777
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:38375753
  • scopus:85185694247
ISSN
1520-7552
DOI
10.1002/dmrr.3777
language
English
LU publication?
yes
id
9a2d0a64-671c-4850-aca8-73b7b1b0885d
date added to LUP
2024-03-25 11:50:27
date last changed
2024-11-19 11:45:05
@article{9a2d0a64-671c-4850-aca8-73b7b1b0885d,
  abstract     = {{<p>Background/Aim: Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. Methods: Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies. Results: The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented. Conclusions: As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.</p>}},
  author       = {{Hendriks, A. Emile J. and Marcovecchio, M. Loredana and Besser, Rachel E.J. and Bonifacio, Ezio and Casteels, Kristina and Elding Larsson, Helena and Gemulla, Gita and Lundgren, Markus and Kordonouri, Olga and Mallone, Roberto and Pociot, Flemming and Szypowska, Agnieszka and Toppari, Jorma and Berge, Thekla von dem and Ziegler, Anette G. and Mathieu, Chantal and Achenbach, Peter}},
  issn         = {{1520-7552}},
  keywords     = {{monitoring; presymptomatic type 1 diabetes; primary care; screening; specialist care; staging}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Diabetes/Metabolism Research and Reviews}},
  title        = {{Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes}},
  url          = {{http://dx.doi.org/10.1002/dmrr.3777}},
  doi          = {{10.1002/dmrr.3777}},
  volume       = {{40}},
  year         = {{2024}},
}