A Real-World Beta-Cell Preservation Framework in Type 1 Diabetes: Consensus from the T1D Exchange (T1DX-QI).

Abstract

Objective: Type 1 diabetes (T1D) follows a trajectory defined by four stages. Autoantibody screening and disease-modifying therapy (DMT) strategies to preserve beta-cell function are rapidly emerging. Clinical implementation guidance is limited.

Methods: A national group of pediatric and adult endocrinology experts was formed through invitation by a nonprofit network of over 60 centers. Experts were invited based on their expertise in autoantibody (AAB) screening for T1D and treating children and adults at risk for T1D. The group comprised 22 experts from 13 academic medical centers across the U.S. Group meetings were held from November 2025 to February 2026 to agree on topics for inclusion, form writing groups, and develop evidence-based statements using a targeted literature search.

Results: Topics covered include current guidelines, AAB screening framework, early stage and stage 3 T1D, clinical protocol for T1D screening, treatment and Quality Improvement framework, education, social and behavioral considerations, and the implementation gap. Early identification of T1D through screening allows additional time for families to receive comprehensive diabetes education and appropriate psychological support. This provides a smoother transition to stage 3 disease while reducing hospitalizations, length of stay, and allowing consideration of DMT in early stage or stage 3 T1D. Guidance on real-world clinical implementation of T1D AAB screening and DMT remains limited.

Conclusion: This article provides a national consensus from T1DX-QI on the clinical implementation of T1D AAB screening in those at risk and DMT for beta-cell preservation for individuals in stage 2 and new onset stage 3 T1D.