ADA Scientific Sessions showcase innovations and guidance for early risk monitoring of type 1 diabetes

At the recent 84th American Diabetes Association (ADA) Scientific Sessions, held in Orlando, Florida, from June 21 to 24, the diabetes community learned of developments in risk monitoring for type 1 diabetes and how to improve care for people with early-stage type 1 diabetes. The new research highlights the benefits of continuous glucose monitoring (CGM) metrics in predicting type 1 diabetes progression and risk.

In 2022, approximately 8.75 million people were living with type 1 diabetes, with 1.52 million under the age of 20. The exact causes of type 1 diabetes are unknown. However, research shows that the possibility of developing the condition increases slightly if a family member has it. Also, environmental factors, such as exposure to a viral infection, can trigger an autoimmune reaction leading to type 1 diabetes.

The potential of early screening and risk monitoring in treating type 1 diabetes can be pivotal to reducing the risk of diabetes-related complications. The studies and guidance statement presented at this year’s ADA Scientific Sessions hold immense promise in paving the way for a new treatment era for people with type 1 diabetes.

Monitoring guidance provides clear, actionable advice for healthcare professionals

Researchers from Schneider Children’s Medical Center of Israel and Riley Children’s Health at Indiana University Health presented a new consensus statement for monitoring autoantibody-positive individuals in early-stage type 1 diabetes. This guidance, for primary and speciality care healthcare professionals, provides clear, actionable advice on following up during the early, preclinical stages of type 1 diabetes for improved patient care. It also covers specific advice on caring for children, adolescents and adults with additional educational and psychosocial advice.

This shift in type 1 diabetes care can lead to early intervention before symptoms appear and insulin is required. Among the key points presented were the benefits of early detection of type 1 diabetes, including reduced risk of diabetic ketoacidosis (DKA), increased planning and preparation time and the opportunity to consider new methods for delaying and preventing type 1 diabetes.

Breakthrough T1D (formerly JDRF) led the development of the consensus guidance endorsed by ADA and the European Association for the Study of Diabetes and published in Diabetes Care and Diabetologia.

Using CGM data to identify the risk of developing type 1 diabetes

By collecting metrics from people with one or more type 1 diabetes markers, researchers were able to develop a CGM model to predict and classify the condition in people at risk. The markers used were positive islet autoantibody (IAb) typeS).

The study combined baseline CGM data from five studies including the Autoimmunity Screening for Kids (ASK), Belgian Diabetes Registry (BDR), Diabetes Autoimmunity Study in the Young (DAISY), Type 1 Diabetes Prediction and Prevention (DIPP), and TrialNet Pathway to Prevention (TrialNet) with a median follow-up time of 2.6 years. A CGM and baseline factor model and a baseline-only model were compared. The CGM model classified participants’ risk of developing stage 3 type 1 diabetes within two years as low (less than 10%), medium (10 up to 30%), or high (equal to or above 30%). The results indicated that a participant’s probability of developing type 1 diabetes within two years was 4%, 17%, and 51% in the low-, medium-, and high-risk groups respectively.

The authors hope future drug trials will use CGM metrics as an eligibility requirement to identify those at the highest risk of progression. People with one or more positive islet autoantibodies could use CGMs temporarily to better understand their risk of developing stage 3 type 1 diabetes.