Metabolic Monitoring in Individuals with Presymptomatic Autoimmune Type 1 Diabetes

Learning Objectives

• Educate on the metabolic tools available to HCPs for autoimmune T1D staging and monitoring

Summary

People with confirmed autoantibody-positive status should undergo monitoring for disease progression. 

Monitoring of individuals with presymptomatic autoimmune type 1 diabetes, combined with appropriate education, may improve outcomes at clinical onset of Stage 3. 

Multiple tools are available to monitor glycemic control. 

Self-monitoring of blood glucose is a simple, low-cost option. However, it can be uncomfortable, potentially affecting accuracy and repeat usage. 

Random glucose, based on a blood draw or fingerstick test, is also a simple test. However, it is less sensitive than OGTT. 

Continuous glucose monitoring, or CGM, is convenient and can be worn at home. However, there is a risk of anxiety for users, as the devices display glucose fluctuations and may sound alarms, so appropriate education is required. 

OGTT is a well-established methodology, but the patient must spend some time in the clinic, as the test requires a fasted blood draw, glucose loading, and a second blood draw two hours later.  

The standard HbA1c test is highly specific for diagnosis of Stage 3 autoimmune type 1 diabetes. Longitudinal HbA1c may be as informative as OGTT. However, results can be affected by age or by the presence of other diseases. 

C-peptide testing measures beta-cell function. Serial measurement during an OGTT tracks deterioration of beta-cell function and predicts risk of progression. 

As screening for autoimmune type 1 diabetes becomes more common, the demand for monitoring will increase, often in primary-care settings. An understanding of these tools will help ensure the best use is made of available resources. 

MAT-GLB-2405119-1.0 08/2024