Recommendations for Screening and Monitoring the Stages of Type 1 Diabetes in the Immune Therapy Era

Daniel J Moore,1 Natasha I Leibel,2 William Polonsky,3 Henry Rodriguez4 1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Pediatrics, Columbia University, New York, NY, USA; 3Behavioral Diabetes Institute, San Diego, CA, USA; 4USF Diabetes and Endocrinology Center, Morsani College of Medicine, University of South Florida, Tampa, FL, USACorrespondence: Henry Rodriguez, USF Diabetes and Endocrinology Center, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs. Blvd. MDC 62, Tampa, FL, 3612, USA, Tel +1 813-821-8011, Fax +1 813-974-3313, Email hrodrig1@usf.eduAbstract: Type 1 diabetes (T1D) is a complex, chronic autoimmune disease that affects over 1.6 million people in the United States. It is now understood that T1D may be undetected for many years while the disease progresses quietly without producing symptoms. T1D can be identified through diabetes-related autoantibody screening and staged accordingly, enabling healthcare providers to identify high-risk individuals in the early stages of the disease and either provide a stage-specific intervention or offer clinical trial opportunities to preserve beta cell function and anticipate the onset of clinical T1D. Evidence-based clinical practice guidelines currently do not exist for routine diabetes-related autoantibody screening of individuals at risk of developing T1D or of the general population. The purpose of this article is to help clinicians acquire an understanding of the rationale and protocols recommended for identifying patients at risk of developing T1D and monitoring such patients for autoimmune markers and progression of disease from Stage 1 to Stage 3 (clinical disease).Plain Language Summary: Type 1 diabetes (T1D) is a life-long condition where the body’s immune system (which normally fights infection) mistakenly attacks cells in the pancreas that make insulin. Insulin allows one to use energy from food and controls blood sugar levels. Without early recognition and treatment, high blood sugar can cause serious symptoms and life-threatening complications, such as diabetic ketoacidosis (DKA). DKA happens when there is very low insulin, and if not spotted early, it can cause coma and death. T1D can occur at any age. The chance of getting T1D is higher if another family member has it. T1D progresses silently for months or years before symptoms appear such as increased thirst, frequent urination, and unintentional weight loss. Healthcare providers can now screen and identify people who are at early stages of T1D (without symptoms) with blood tests called autoantibodies. Early detection through screening allows people to 1) learn about the disease before symptoms start and insulin is needed, 2) potentially receive treatments that delay T1D progression, and 3) participate in research trials. By detecting T1D at early stages, people can connect with the right care team and develop the skills needed to manage later stage T1D. Early detection has been shown to prevent hospitalization and life-threatening conditions. Screening for T1D will help people maximize their opportunities to delay T1D onset while preparing for diabetes care. Keywords: Type 1 Diabetes, autoantibodies, screening, immunotherapy