New guidelines signal paradigm shift in type 1 diabetes

Up to 90% of people who develop type 1 diabetes are not part of at-risk groups. Screening programmes within the general population are being initiated and guidance for monitoring in non-specialist settings is urgently needed.

This week marks a paradigm shift in the monitoring of type 1 diabetes (T1D). The Juvenile Diabetes Research Foundation (JDRF), along with 66 international experts and over 10 diabetes organisations, published new T1D monitoring guidance for healthcare professionals outlining how to detect and monitor early-stage T1D, before the point of symptom onset.

The chronic autoimmune condition is traditionally diagnosed when elevated blood glucose levels result in the symptoms of thirst, weight loss, tiredness, and increased urination. At this point, exogenous insulin is already required, meaning diagnosis often occurs at the point of critical illness with hospital admission and diabetic ketoacidosis (DKA), particularly in children.

Professor Jennifer Couper, endocrinologist and co-author of the consensus document, said there is a real need for this guidance.

“There has been a push internationally to introduce screening for type 1 diabetes in the general population, before symptoms develop, but no guidance on how to care for individuals who are identified at these early stages.

“We know that early detection is important to prevent DKA at diagnosis and to better support families so that the transition to treatment is less stressful for them. Early detection also identifies people who are eligible to enter clinical trials testing immune therapies which show promise in slowing down type 1 diabetes progression.

“However, until now, there has been little information on how best to detect individuals in the early stages of type 1 diabetes, how to monitor them, and the role of different healthcare providers in this process. This consensus document fills that gap with the overall goal to greatly improve the lives of those with type 1 diabetes.”

The guidance document has been endorsed by numerous key diabetes organisations including the American Diabetes Association, European Association for the Study of Diabetes, and the Australian Diabetes Society.

JDRF Australia funds two screening programs aimed at early-stage T1D detection, with Australia on track to become one of the first countries in the world to adopt childhood general population screening for the condition. These programs are called the Australian Type 1 Diabetes National Screening Pilot and the Type 1 Screen. These are led by Dr Kirstine Bell and Associate Professor John Wentworth respectively, also co-authors of the guidance document.

Dr Dorota Pawlak, JDRF Australia’s Chief Scientific Officer, said the newly published guidance and progress in early-stage T1D screening represent a paradigm shift in how we think about and diagnose the condition.

“The evidence from the last couple of decades of research revealed a long asymptomatic stage of T1D before the first signs of symptoms begin. Years of JDRF’s investment have been directed into understanding the markers of pre-symptomatic type 1 diabetes.

“To see this investment come to fruition through the publication of this consensus guidance is incredibly exciting for us. We are proud that we have not only been able to fund the initial research in this area, but also push it through the research pipeline by driving and coordinating the development of this guidance document,” Dr Pawlak explained.

JDRF’s Type 1 Diabetes Clinical Research Network (CRN) has received continued support from the Australian government to enable ongoing investment in ground-breaking type 1 diabetes research.

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