Overview

Autoimmune type 1 diabetes (T1D) is a progressive disease in which autoreactive T cells cause progressive loss of insulin-producing pancreatic islet beta cells.¹ Affected individuals progress through four stages, which are recognised based on autoantibody status and clinical features.² Clinical onset and insulin dependency define Stage 3, with children typically progressing more rapidly from autoantibody positivity to Stage 3 than adults.³ Population-based screening and early diagnosis of presymptomatic T1D can lead to milder T1D at clinical onset.⁴ Screening should involve testing for autoantibodies to insulin, GAD, IA-2 or ZnT8, with detection of multiple autoantibodies indicating risk for T1D onset.⁵ For children and adults who test positive for islet autoantibodies, recent guidelines recommend monitoring by primary care physicians as well as endocrinologists and other specialists.⁶ Monitoring frequency and methodology depend on age, time since autoantibody detection, number of autoantibodies and presence of T1D symptoms. Key recommendations include confirming autoantibody status with a second sample, metabolic monitoring for disease progression, and providing both disease education and psychosocial support to affected individuals and their families.⁶ Overall, the goal is to prevent T1D complications and allow patients to benefit from earlier management strategies.