[Plea for an early diagnosis of people at risk of developing symptomatic type 1 diabetes].

Abstract

Type 1 diabetes (T1D) is an autoimmune chronic disease that leads to the destruction of pancreatic beta cells and thus requires lifelong insulin therapy. Constraints and adverse events associated to insulin therapy are well known as well as the risk of long-term complications linked to chronic hyperglycaemia. Symptomatic T1D is preceded by a preclinical asymptomatic period, which is characterized by the presence of at least two auto-antibodies against beta cell without disturbances of blood glucose control (stage 1) or, in addition to immunological biomarkers, by the presence of mild dysglycaemia reflecting a defect of early insulin secretion (stage 2). Recent objectives for the management of this disease are to detect people with auto-antibodies in order to propose an early specific management to delay the shift to clinical stage (stage 3) and to limit its severity as well. The screening concerns as first step relatives of patients living with T1D and individuals presenting other auto-immune diseases, but may be extended to the general population (especially in young people) with the improvement of techniques of auto-antibody assays. Teplizumab, an anti-CD3 monoclonal antibody, slows down the decline of insulin secretion by beta cells, both in people at stage 2 and early stage 3. This medication, which may be considered as a disease-modifying agent of T1D, was approved in November 2022 by the U.S. Food and Drug Administration (FDA) and is currently evaluated by the European Medicines Agency (EMA).