FIP 2025 Symposium Summary

In the opening presentation, Prof. Luigi Meneghini discussed the progression of T1D from presymptomatic stage to clinical onset, challenges in T1D diagnosis, and evolution of treatment / management approaches.
 

• Autoimmune type 1 diabetes (T1D) incidence peaks in adolescents aged 10–14, but more than half of new diagnoses now occur in adults. T1D imposes a significant burden, requiring constant management of insulin dosing, prevention of diabetic ketoacidosis (DKA), hypoglycemia management, and addressing psychosocial and socioeconomic impacts.^2–10 
• Pathophysiology of T1D involves a complex autoimmune process of damaging pancreatic beta cells, primarily driven by T cells.^11–13
• Autoantibodies such as IAA, GAD, IA2, and ZnT8 serve as early indicators of this autoimmune process, typically autoantibody seroconversion peaking between 9 months and 2 years of age in children who later develop clinical T1D.¹⁴ 
• Early detection of T1D is often associated with potential benefits through autoantibody screening and with lower rates of DKA at diagnosis from approximately 62% to less than 5%.^15–17  
• T1D stages are based on autoantibody positivity and glycemic status: Stage 1 (≥2 autoantibodies with normoglycemia), Stage 2 (≥2 autoantibodies with dysglycemia), Stage 3 (clinical diabetes requiring insulin), and Stage 4 (long-standing T1D), with progression rates from Stage 1 to Stage 3 at 44% over five years and from Stage 2 to Stage 3 at 75% over four to five years.^18–20 
• Screening is suggested to start at age 2 with repeat screening at ages 5-7 for children,²¹ with particular focus on first-degree relatives who have a 10-15-fold increased risk, though notably 85% of T1D cases have no family history.^22,23 
• Monitoring frequency should be tailored based on autoantibody number, disease stage, and patient age, using tools such as oral glucose tolerance tests, A1C measurements, and/or continuous glucose monitors.²⁴ 
• Various interventions are being investigated, targeting different aspects of the autoimmune process to preserve beta-cell function and potentially slow or prevent disease progression.^25–34 Some of the trials also reported greater C-peptide levels which is associated with improved metabolic outcomes.^35,36
   

Dr. Astrid Czock discussed the role of pharmacists as an integral member of the interprofessional care team in the journey of T1D management.

• Pharmacists function as essential healthcare providers, serving as a crucial bridge between patients and other healthcare professionals throughout the diabetes care continuum including identification of at-risk individuals, education about symptoms and early detection, conducting pharmacy-based screenings, explaining test results, and referring the individuals to specialists within their professional network.¹ 
• Findings from the UKPDS study revealed that 27% of young adults (aged 25-44 years) newly diagnosed with T2D also tested positive for two T1D autoantibodies, necessitating completely different treatment approaches and disease management.² 
• TrailNet PTP study showed that the adults who were found to have both dysglycemia and multiple positive islet autoantibodies (Stage 2 T1D) at screening, progressed at the same rapid rate to Stage 3 T1D as children in Stage 2 T1D, and those who had follow-up had lower 5-year risk of progression to Stage 3 T1D.³
• Pharmacists should educate patients using simple, consistent, and actionable language about disease pathophysiology, clinical signs, monitoring device usage, and warning signs requiring medical attention.^4,5
• Pharmacists ensure continuity of care through ongoing education, monitoring adherence, addressing psychosocial concerns, and supporting patients with medication questions.^1,5-10
• Pharmacists should be integral members of interprofessional care teams, and could play a key role in national level T1D screening programs.¹¹