Type 1 diabetes (T1D) diagnoses could soon be transformed with newly released guidance outlining how to detect and monitor early-stage T1D, before the point of symptom onset.

John Wentworth T1D
Endocrinologist Associate Professor John Wentworth

International T1D experts, including those from the RMH, have co-authored a consensus document in Diabetes Care and Diabetologia, outlining the best methods and recommended frequency for monitoring the progression of T1D across pre-symptomatic stages.

T1D is traditionally diagnosed when people present to their GP with symptoms of thirst, weight loss, tiredness and increased urination. Insulin is already required at this point, meaning diagnosis often occurs too late and can result in sudden hospitalisation.

Research, however, has shown that the condition starts months or even years before symptoms are present. Called pre-symptomatic T1D, identifying the condition in its early stages has significant health benefits, including preventing severe and sudden illness and long-term health complications, and improved blood glucose control.

Prior to the consensus document, there was no standard advice on how to detect, follow up, or support people with early-stage T1D. The document also outlines at what point insulin should be introduced to people living with pre-symptomatic T1D, including adults, children, and pregnant individuals.

The document also outlines the types of partnerships required among health care practitioners to ensure pre-symptomatic detection and follow up is successful, and the educational needs and psychosocial support that individuals and families may require.

The guidance document has been endorsed by numerous key diabetes organisations including the American Diabetes Association, the European Association for the Study of Diabetes, and the Australian Diabetes Society.

Researchers on the consensus document include JDRF-funded Australian researchers the Royal Melbourne Hospital and WEHI’s Associate Professor John Wentworth, University of Adelaide’s Professor Jennifer Couper, Charles Perkins Centre at the University of Sydney’s Dr Kirstine Bell and UNSW’s Professor Maria Craig.

JDRF Australia funds two screening programs aimed at early-stage T1D detection, with Australia on track to become one of the first countries in the world to adopt childhood general population screening for the condition. These programs are led by Associate Professor John Wentworth and Dr Kirstine Bell - both co-authors of the guidance document.

JDRF Australia’s Chief Scientific Officer Dr Dorota Pawlak said the newly published guidance and progress in early-stage T1D screening represent a paradigm shift in how we think about and diagnose the condition.

“The evidence from the last couple of decades of research revealed a long asymptomatic stage of T1D before the first signs of symptoms begin. Years of JDRF’s investment have been directed into understanding the markers of pre-symptomatic type 1 diabetes.

“To see this investment come to fruition through the publication of this consensus guidance is incredibly exciting for us. We are proud that we have not only been able to fund the initial research in this area, but also push it through the research pipeline by driving and coordinating the development of this guidance document.”

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