Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes,Diabetes Care

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Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes
Diabetes Care ( IF 14.8 ) Pub Date : 2024-06-26 , DOI: 10.2337/dci24-0042
Moshe Phillip _{1,

2} , Peter Achenbach _{3,

4} , Ananta Addala _{5,

6} , Anastasia Albanese-O'Neill ₇ , Tadej Battelino _{8,

9} , Kirstine J Bell ₁₀ , Rachel E J Besser _{11,

12} , Ezio Bonifacio _{13,

14} , Helen M Colhoun _{15,

16} , Jennifer J Couper _{17,

18,

19} , Maria E Craig _{10,

20} , Thomas Danne ₂₁ , Carine de Beaufort _{22,

23,

24} , Klemen Dovc _{8,

9} , Kimberly A Driscoll _{25,

26,

27} , Sanjoy Dutta ₂₈ , Osagie Ebekozien ₂₉ , Helena Elding Larsson _{30,

31} , Daniel J Feiten ₃₂ , Brigitte I Frohnert ₂₅ , Robert A Gabbay ₃₃ , Mary P Gallagher ₃₄ , Carla J Greenbaum ₃₅ , Kurt J Griffin _{36,

37} , William Hagopian ₃₈ , Michael J Haller _{27,

39} , Christel Hendrieckx _{40,

41,

42} , Emile Hendriks ₄₃ , Richard I G Holt _{44,

45} , Lucille Hughes ₄₆ , Heba M Ismail ₄₇ , Laura M Jacobsen ₃₉ , Suzanne B Johnson ₄₈ , Leslie E Kolb ₄₉ , Olga Kordonouri ₂₁ , Karin Lange ₅₀ , Robert W Lash ₅₁ , Åke Lernmark ₃₀ , Ingrid Libman ₅₂ , Markus Lundgren _{30,

53} , David M Maahs ₅ , M Loredana Marcovecchio ₅₄ , Chantal Mathieu ₅₅ , Kellee M Miller ₂₉ , Holly K O'Donnell ₂₅ , Tal Oron _{1,

2} , Shivajirao P Patil ₅₆ , Rodica Pop-Busui ₅₇ , Marian J Rewers ₂₅ , Stephen S Rich ₅₈ , Desmond A Schatz ₅₉ , Rifka Schulman-Rosenbaum ₆₀ , Kimber M Simmons ₂₅ , Emily K Sims ₆₁ , Jay S Skyler ₆₂ , Laura B Smith ₆₃ , Cate Speake ₃₅ , Andrea K Steck ₂₅ , Nicholas P B Thomas ₆₄ , Ksenia N Tonyushkina ₆₅ , Riitta Veijola ₆₆ , John M Wentworth _{67,

68} , Diane K Wherrett ₆₉ , Jamie R Wood ₇₀ , Anette-Gabriele Ziegler _{3,

4} , Linda A DiMeglio ₄₆

Affiliation

Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany.
Forschergruppe Diabetes, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA.
Breakthrough T1D, Gainesville, FL.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Department of Endocrinology, Diabetes and Metabolism, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre Human Genetics, Nuffield Department of Medicine Oxford National Institute for Health and Care Research Biomedical Research Centre, University of Oxford, Oxford, U.K.
Department of Paediatrics, University of Oxford, Oxford, U.K.
Center for Regenerative Therapies Dresden, Faculty of Medicine, Technical University of Dresden, Dresden, Germany.
Paul Langerhans Institute Dresden, Helmholtz Centre Munich at the University Clinic Carl Gustav Carus of Technical University of Dresden, and Faculty of Medicine, Technical University of Dresden, Dresden, Germany.
The Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, U.K.
Department of Public Health, NHS Fife, Kirkcaldy, U.K.
Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia.
Breakthrough T1D, Lisbon.
International Society for Pediatric and Adolescent Diabetes (ISPAD), Berlin, Germany.
Diabetes & Endocrine Care Clinique Pédiatrique (DECCP), Clinique Pédiatrique/Centre Hospitalier (CH) de Luxembourg, Luxembourg City, Luxembourg.
Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-Belval, Luxembourg.
Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.
Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.
Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL.
Breakthrough T1D, New York, NY.
T1D Exchange, Boston, MA.
Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Department of Pediatrics, Skåne University Hospital, Malmö and Lund, Sweden.
Children's Diabetes Foundation, Aurora, CO.
American Diabetes Association, Arlington, VA.
NYU Langone Medical Center, New York, NY.
Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA.
Sanford Research, Sioux Falls, SD.
Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.
Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, WA.
Division of Endocrinology, University of Florida College of Medicine, Gainesville, FL.
School of Psychology, Deakin University, Geelong, Victoria, Australia.
The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia.
Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K.
National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K.
Mount Sinai South Nassau, Oceanside, NY.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL.
Association of Diabetes Care & Education Specialists, Chicago, IL.
Medical Psychology, Hannover Medical School, Hannover, Germany.
Endocrine Society, Washington, DC.
Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, PA.
Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden.
Department of Pediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium.
Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI.
Center for Public Health Genomics, University of Virginia, Charlottesville, VA.
Department of Pediatrics, University of Florida, Gainesville, FL.
Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
Division of Pediatric Endocrinology and Diabetology, Herman B Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN.
Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
National Institute of Health and Care Research Clinical Research Network Thames Valley and South Midlands, Oxford, U.K.
Division of Endocrinology and Diabetes, Baystate Children's Hospital and University of Massachusetts Chan Medical School-Baystate, Springfield, MA.
Research Unit of Clinical Medicine, Department of Pediatrics, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.
The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH.

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 programs are being increasingly emphasized. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody–positive (IAb+) children and adults who are at risk for (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 nonspecialized 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 emphasizes significant unmet needs for further research on early-stage type 1 diabetes to increase the rigor of future recommendations and inform clinical care.

中文翻译：

监测胰岛自身抗体阳性 3 期前 1 型糖尿病个体的共识指南

鉴于筛查对降低 3 期 1 型糖尿病诊断时糖尿病酮症酸中毒（DKA）可能性的益处已得到证实，以及延缓疾病进展的疗法的出现，1 型糖尿病筛查计划越来越受到重视。一旦广泛实施，筛查计划将识别大量胰岛自身抗体阳性（IAb+）儿童和成人，这些儿童和成人有患（确诊单个 IAb+）或患有（多个 IAb+）早期（1 期和 2 期）1 型糖尿病的风险。这些人需要监测疾病进展;大部分这种护理将在非专业环境中进行。为了为这种监测提供信息，JDRF 与国际专家和学会合作，制定了共识指南。该指南的广泛建议包括以下内容：1）应促进内分泌学家和初级保健提供者之间的伙伴关系，以照顾 IAb+ 患者;2）当最初确定 IAb+ 人群时，需要使用第二个样本进行确认;3）单个 IAb+ 个体的进展风险低于多个 IAb+ 个体;4）早期 1 型糖尿病患者应定期进行医学监测，包括定期评估血糖水平、定期进行糖尿病和 DKA 症状教育以及社会心理支持;5）应向感兴趣的 2 期 1 型糖尿病患者提供试验参与或批准的疗法;6）所有参与监测和护理 1 型糖尿病患者的卫生专业人员都有责任提供教育。该指南还强调了对早期 1 型糖尿病的进一步研究的重大未满足需求，以提高未来建议的严谨性并为临床护理提供信息。

更新日期：2024-06-26

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