Establishing Screening Programs for Presymptomatic Type 1 Diabetes: Practical Guidance for Diabetes Care Providers.

Abstract

Type 1 diabetes (T1D) is an autoimmune disease with two presymptomatic stages (stages 1 and 2) that precede its clinical onset (stage 3). The presymptomatic stages of T1D are characterized by circulating autoantibodies that can be reliably detected by autoantibody screening panels. Identifying people in the presymptomatic stages of T1D can allow for monitoring and prevention of diabetic ketoacidosis. A disease-modifying therapy that has been shown to delay onset of stage 3 T1D is now also available for individuals with stage 2 disease, highlighting the importance of early detection. This intervention may delay the onset of stage 3 T1D. Updated guidance and protocols are needed to integrate autoantibody screening into standard practice. This report provides guidance for endocrinology providers on establishing clinical autoantibody screening programs within their practices, institutions, healthcare networks, and/or communities. Key steps include nominating a champion for the program, building a team to implement screening, and motivating other providers to participate. Implementation of screening requires standardizing several steps in the screening process, including communicating with individuals at risk, integrating screening into existing workflows, and streamlining logistics such as ordering and coding for autoantibody panels. Providers must have a plan to interpret and communicate results and to ensure that individuals may be appropriately followed in the future. Here, common barriers to screening are addressed, and practical solutions to facilitate the adoption and success of screening initiatives are offered.