Article Dans Une Revue Diabetes & Metabolism Année : 2025

Screening and care for preclinical stage 1–2 type 1 diabetes in first-degree relatives: French expert position statement

Roberto Mallone
Elise Bismuth
  • Fonction : Auteur
Charles Thivolet
  • Fonction : Auteur
Nadine Hoffmeister
  • Fonction : Auteur
François Collet
  • Fonction : Auteur
Marc Nicolino
  • Fonction : Auteur
Rachel Reynaud
  • Fonction : Auteur
Jacques Beltrand
  • Fonction : Auteur

Résumé

The natural history of type 1 diabetes (T1D) evolves from stage 1 (islet autoimmunity with normoglycemia; ICD-10 diagnostic code E10.A1) to stage 2 (autoimmunity with dysglycemia; E10.A2) and subsequent clinical stage 3 (overt hyperglycemia), which is commonly the first time of referral. Autoantibody testing can diagnose T1D at its preclinical stages 1-2 and lead to earlier initiation of care, particularly for first-degree relatives of people living with T1D, who are at higher genetic risk. Preclinical T1D screening and monitoring aims to avoid inaugural ketoacidosis and prolong preservation of endogenous insulin secretion, thereby improving glycemic control and reducing long-term morbidity. Moreover, early management can help coping with T1D and correct modifiable risk factors (obesity, sedentary lifestyle). New treatments currently under clinical deployment or trials also offer the possibility of delaying clinical progression. All these arguments lead to the proposition of a national screening and care pathway open to interested first-degree relatives. This pathway represents a new expertise to acquire for healthcare professionals. By adapting international consensus guidance to the French specificities, the proposed screening strategy involves testing for ≥ 2 autoantibodies (among IAA, anti-GAD, anti-IA-2) in relatives aged 2-45 years. Negative screening (~95 % of cases) should be repeated every 4 years until the age of 12. A management workflow is proposed for relatives screening positive (~5 % of cases), with immuno-metabolic monitoring by autoantibody testing, OGTT, glycemia and/or HbA1c of variable frequency, depending on T1D

Mots clés

Autoantibodies Insulin secretion Ketoacidosis OGTT Screening Stages aAb, autoantibodies ADAP, antibody detection by agglutination-PCR BMI, body mass index CGM, continuous glucose monitoring CI, confidence interval DKA, diabetic ketoacidosis ECL, electrochemiluminescence ELISA, enzyme-linked immunosorbent assay GAD, glutamate decarboxylase GRS, genetic risk score HLA, human leukocyte antigen HR, hazard ratio IAA, insulin auto-antibodies IA-2, tyrosine phosphatase IASP, Islet Autoantibody Standardization Program ICA, islet cell antibodies ICD-10, International Classification of Diseases 10 OGTT, oral glucose tolerance test LIPS, luciferaseimmuno precipitation system PwT1D, person living with type 1 diabetes SMBG, self-monitoring blood glucose T1D, type 1 diabetes TATR, time above tight range TITR, time in tight range ZnT8, zinc transporter 8 Autoantibodies Insulin secretion Ketoacidosis OGTT Screening Stages aAb, autoantibodies ADAP, antibody detection by agglutination-PCR BMI, body mass index CGM, continuous glucose monitoring CI, confidence interval DKA, diabetic ketoacidosis ECL, electrochemiluminescence ELISA, enzyme-linked immunosorbent assay GAD, glutamate decarboxylase GRS, genetic risk score HLA, human leukocyte antigen HR, hazard ratio IAA, insulin auto-antibodies IA-2, tyrosine phosphatase IASP, Islet Autoantibody Standardization Program ICA, islet cell antibodies ICD-10, International Classification of Diseases 10 OGTT, oral glucose tolerance test LIPS, luciferaseimmuno precipitation system PwT1D, person living with type 1 diabetes SMBG, self-monitoring blood glucose T1D, type 1 diabetes TATR, time above tight range TITR, time in tight range ZnT8, zinc transporter 8
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hal-04923860 , version 1 (31-01-2025)

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Roberto Mallone, Elise Bismuth, Charles Thivolet, Pierre-Yves Benhamou, Nadine Hoffmeister, et al.. Screening and care for preclinical stage 1–2 type 1 diabetes in first-degree relatives: French expert position statement. Diabetes & Metabolism, 2025, 51 (1), pp.101603. ⟨10.1016/j.diabet.2024.101603⟩. ⟨hal-04923860⟩

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