Leichter Steven B, Felton Jamie L, Geno Rasmussen Cristy, Rizzuto Patrick, Bellini Natalie, Ebekozien Osagie, Schulman-Rosenbaum Rifka
Piedmont Endocrinology Columbus, Columbus, GA 31904, USA.
Department of Internal Medicine, Mercer University School of Medicine, Columbus, GA 31901, USA.
J Clin Endocrinol Metab. 2025 Jul 15;110(8):2371-2382. doi: 10.1210/clinem/dgaf194.
Type 1 diabetes (T1D) is an autoimmune disease with 2 presymptomatic stages (stages 1 and 2) that precede its clinical onset (stage 3). The presymptomatic stages of T1D are characterized by circulating autoantibodies that can be reliably detected by autoantibody screening panels. Identifying people in the presymptomatic stages of T1D can allow for monitoring and prevention of diabetic ketoacidosis. A disease-modifying therapy that has been shown to delay onset of stage 3 T1D is now also available for individuals with stage 2 disease, highlighting the importance of early detection. This intervention may delay the onset of stage 3 T1D. Updated guidance and protocols are needed to integrate autoantibody screening into standard practice. This report provides guidance for endocrinology providers on establishing clinical autoantibody screening programs within their practices, institutions, healthcare networks, and/or communities. Key steps include nominating a champion for the program, building a team to implement screening, and motivating other providers to participate. Implementation of screening requires standardizing several steps in the screening process, including communicating with individuals at risk, integrating screening into existing workflows, and streamlining logistics such as ordering and coding for autoantibody panels. Providers must have a plan to interpret and communicate results and to ensure that individuals may be appropriately followed in the future. Here, common barriers to screening are addressed, and practical solutions to facilitate the adoption and success of screening initiatives are offered.
1型糖尿病（T1D）是一种自身免疫性疾病，在临床发病（3期）之前有两个症状前期阶段（1期和2期）。T1D的症状前期阶段的特征是存在循环自身抗体，可通过自身抗体筛查组合可靠地检测到。识别处于T1D症状前期阶段的人可以对糖尿病酮症酸中毒进行监测和预防。一种已被证明可延迟3期T1D发病的疾病改善疗法现在也可供2期疾病患者使用，这凸显了早期检测的重要性。这种干预可能会延迟3期T1D的发病。需要更新的指南和方案，以便将自身抗体筛查纳入标准实践。本报告为内分泌科医生在其诊所、机构、医疗保健网络和/或社区内建立临床自身抗体筛查项目提供指导。关键步骤包括为该项目指定一名负责人、组建一个实施筛查的团队，以及激励其他医生参与。实施筛查需要对筛查过程中的几个步骤进行标准化，包括与有风险的个体沟通、将筛查纳入现有工作流程，以及简化诸如订购和编码自身抗体检测组合等后勤工作。医生必须有一个解释和传达结果的计划，并确保未来可以对个体进行适当的跟踪。在此，讨论了筛查的常见障碍，并提供了促进筛查举措的采用和成功的实际解决方案。
