An international consensus on screening and monitoring early-stage type 1 diabetes: A roadmap to European implementation

Type 1 diabetes (T1D) is a chronic autoimmune disease that results in loss of insulin-secreting pancreatic β-cells in the islets of Langerhans. A diagnosis of T1D is typically associated with children and adolescents, yet half of all diagnoses of T1D are made in adults. In children and adolescents, T1D is often first recognized following hospitalization for diabetic ketoacidosis (DKA), which occurs in approximately 20%–50% of new-onset T1D for people younger than 18 years of age in Europe. For adults with new-onset T1D, DKA rates of up to 24% are estimated. Early-stage T1D, during the asymptomatic period, can be detected through screening for multiple islet autoantibodies in blood samples, including capillary and venous samples, and such programs are made more popular by the availability of disease-modifying therapies for early-stage T1D. For individuals who screen positive for early-stage T1D, participation in monitoring programs can greatly reduce the incidence of DKA once symptomatic hyperglycemia develops, as well as reducing severity of symptoms of T1D at onset. Education and awareness of the clinically relevant features of symptomatic T1D can also support the psychological wellbeing of people with early-stage T1D and minimize distress at the point when insulin treatment is necessary. All of these consequences come with a predicted reduced burden of healthcare costs for managing T1D at a population level, and general population screening for islet autoantibodies is underway. In this European perspective, we discuss the imperatives and the components of implementation of general population screening for early-stage T1D.