International consensus guidance for general population screening for islet autoantibodies to diagnose early-stage type 1 diabetes: a nominal group technique process
Abstract
Type 1 diabetes is an autoimmune disease that targets and destroys insulin-producing beta cells in the pancreatic islets. The incidence of type 1 diabetes is rising globally. At the clinical diagnosis of type 1 diabetes, between 20% and 67% of children and adolescents present with diabetic ketoacidosis (DKA) requiring hospitalisation, and one-third of these require intensive care. Type 1 diabetes can be detected in early stages, prior to the insulin-requiring clinical diagnosis, through screening for islet autoantibodies (IAbs). Identifying individuals with early-stage type 1 diabetes, combined with monitoring of and education on disease progression, prevents DKA and results in a milder clinical onset. This allows for timely insulin initiation in outpatient settings and improved long-term glucose management. Early diagnosis also enables access to novel disease-modifying therapies that can delay the clinical onset of diabetes. In this international consensus, we provide guidance on the principles and practice of implementing general population screening for IAbs to diagnose early-stage type 1 diabetes. We also outline the minimum requirements for establishing effective population screening programmes to diagnose early-stage type 1 diabetes through IAb detection. This consensus statement has been endorsed by the following professional associations: Advanced Technologies & Treatments for Diabetes (ATTD); Association of Diabetes Care and Education Specialists (ADCES); Association Belge Du Diabète; Associazione Medici Diabetologi (AMD); Australian Diabetes Society (ADS); Belgian Diabetes Liga; Breakthrough T1D; Czech Diabetes Society (ČDS); EASD; Finnish Diabetes Association (FDS); Fondazione Italiana Diabete (FID); International Diabetes Federation (IDF)-Europe; International Society of Paediatric and Adolescent Diabetes (ISPAD); Paediatric Endocrinology Nursing Society (PENS); Polish Diabetes Society; Portuguese Diabetes Association (APDP); Sociedade Portuguesa de Diabetologia (SPD); Società Italiana di Diabetologia (SID); Société Francophone du Diabète (SFD) and Type 1 Diabetes Exchange (T1D Exchange).
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Authors: Anette‐Gabriele Ziegler, Marian J. Rewers, Peter Achenbach, Kirstine J. Bell, Ezio Bonifacio, L. A. DiMeglio, Sanjoy Dutta, Helena Elding Larsson, Brigitte I. Frohnert, Kurt Griffin, William A. Hagopian, Laura M. Jacobsen, Karin Lange, Roberto Mallone, Parth Narendran, Tal Oron, Stephen S. Rich, Caitrin W. McDonough, Darja Šmigoc Schweiger, Zdenĕk Šumnı́k, Agnieszka Szypowska, Riitta Veijola, Jurgen Vercauteren, John M. Wentworth, Diane K. Wherrett, Anastasia Albanese-O’Neill
Institutions: University of Florida, Florida College, University of Colorado Anschutz, The University of Sydney, KU Leuven, University of Virginia, University of Toronto, Heinrich Heine University Düsseldorf, Inserm, Indiana University School of Medicine, Indiana University – Purdue University Indianapolis, Charles University, Skåne University Hospital, Université Paris Cité, Centre National de la Recherche Scientifique, Lund University, University of Oulu, Assistance Publique – Hôpitaux de Paris, University of Birmingham, Hospital for Sick Children, SickKids Foundation, Tel Aviv University, Medical University of Warsaw, Technical University of Munich, University of Ljubljana, Ljubljana University Medical Centre, Medizinische Hochschule Hannover, Schneider Children's Medical Center, The Royal Melbourne Hospital, Oulu University Hospital, Technische Universität Dresden, University of South Dakota, Helmholtz Munich, Institut Cochin, German Center for Diabetes Research, Hôpital Cochin, Breakthrough, Deutsches Diabetes-Zentrum e.V., University Hospitals Birmingham NHS Foundation Trust, St Vincents Institute of Medical Research, Benaroya Research Institute, Paul Langerhans Institute Dresden, Center for Regenerative Therapies Dresden, Indiana Biosciences Research Institute, Queen Elizabeth Hospital