Talking international consensus guidance for monitoring pre-stage 3 type 1 diabetes

Linda DiMeglio, MD, MPH, recently shared her insights on the changing landscape of pediatric diabetes care. DiMeglio is the Vice-Chair of the Consensus Monitoring Guidance Working Group and Division Chief for Pediatric Endocrinology and Diabetology at Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana. DiMeglio emphasized the critical role pediatricians play in managing children identified with early-stage type 1 diabetes, especially in light of new screening guidelines and therapeutic advances.

"It's a unique time in the care of children with diabetes in that we've had a paradigm shift to the way that we care for these kids over the last few years," DiMeglio stated. "We now diagnose diabetes before there are clinical symptoms based upon validated islet autoantibody assays, and we know that people with 2 or more of these autoantibodies, when confirmed, have a nearly 100% lifetime risk of developing stage 3 or clinical type 1 diabetes."

The guidance developed by DiMeglio and her colleagues provides recommendations for the clinical management of individuals identified with islet autoantibodies, a marker of early-stage type 1 diabetes. She highlighted the importance of confirming autoantibody results and monitoring blood sugar levels.

"There are a few key elements to the guidance that was proposed," DiMeglio said. "I think the most important thing is that when a child is identified as having islet autoantibodies, those antibodies need to be repeated in a second lab and verified. This is because occasionally we will see people where they're false positive results, and we need to understand that. Secondly, once we identify somebody with auto islet autoantibodies, it's really critical that we know where they are in terms of their blood sugars, and we know if they already have clinical diabetes that needs to be treated, whether they're in stage 2 disease, meaning that they have early evidence of higher blood sugars, but have not yet moved to stage 3 or diabetes requiring insulin, or they have normal blood sugars at that point in time."

DiMeglio also underscored the role of primary care providers, particularly pediatricians, in the ongoing care and monitoring of children with early-stage diabetes.

"Primary care providers must understand the stages of diabetes and the methods of monitoring for abnormal blood sugars and the frequency for monitoring for patients in their practice. Eventually, as people with multiple antibodies progress along to stage 3 diabetes, they will require the care of an endocrinologist," DiMeglio explained.

This transition requires clear communication between the primary care provider, the specialist, and the patient's family to determine who will take primary responsibility for the patient's care. The guidance emphasizes that this collaboration is essential to providing optimal care as the child's condition evolves.

DiMeglio’s insights reflect the growing need for pediatricians to be well-versed in the early stages of diabetes and to be prepared to manage and monitor these patients in collaboration with specialists. As the medical community continues to refine its understanding and approach to type 1 diabetes, the role of the pediatrician remains central to ensuring that children receive timely and appropriate care, from early diagnosis through to the management of the disease as it progresses.

Reference:

Phillip, M., Achenbach, P., Addala, A. et al. Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06205-5