Screening and Monitoring for Presymptomatic Type 1 Diabetes: A Time for Action

Abstract – Background: Historically, type 1 diabetes (T1D) has been diagnosed following symptoms of overt hyperglycemia. However, the autoimmune processes driving the progression of the disease start years prior to the appearance of symptomatic disease. Early stages of T1D can be detected by screening individuals, including young children, for islet autoantibodies. Summary: The goal of this review is to discuss the benefits of early detection for individuals with presymptomatic T1D as well as discuss barriers that currently prevent a more widespread implementation of screening programs. Early detection of T1D can reduce the occurrence and severity of complications associated with clinical onset of T1D, including life-threatening diabetic ketoacidosis. It also facilitates the use of approved novel therapeutics that can delay the progression to clinical T1D and allows individuals to participate in clinical trials for other disease-modifying therapies in development. Despite these benefits, there are knowledge gaps that should be addressed before screening can be implemented optimally in practice. Key Messages: Diagnosis of presymptomatic stages of T1D offers several benefits to individuals and their caregivers. Given the multifaceted benefits screening can provide, this review offers expert perspective on the importance of adopting early-detection strategies to identify presymptomatic stages of T1D as part of clinical care.