A total of 13 scientific societies and patient associations have drawn up a consensus document in which an Integrated Care Process (PAI) is defined for the identification and coordinated, multidisciplinary approach to type 1 diabetes in preclinical phases, that is, before symptoms manifest.
Type 1 diabetes begins when the immune system progressively destroys the beta cells of the pancreas, which are responsible for producing insulin. This process may run without obvious signs at the beginning, so its early detection makes it possible to put in place follow-up measures and early intervention.
The text specifies how to proceed in these initial stages, by defining the groups at higher risk—particularly first-degree relatives of people with type 1 diabetes and those who have a known high genetic risk—to carry out the relevant tests, confirm the results when necessary, and organize appropriate monitoring.
The initiative seeks for all professionals involved to act in a coordinated manner and for the care provided to be homogeneous regardless of the healthcare center where it is carried out.
However, the document clarifies that the proposed pathways are of an indicative nature and that it is up to the Health Services of the autonomous communities to adapt and define them according to their structures and priorities.
Integrating the Alliance for the Early Approach to Type 1 Diabetes in preclinical stages are the Federación Española de Diabetes (FEDE), the Sociedad Española de Endocrinología y Nutrición (SEEN), the Sociedad Española de Diabetes (SED), the Sociedad Española de Endocrinología Pediátrica, the Sociedad Española de Medicina Preventiva, Salud Pública y Gestión Sanitaria, and the Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP).
In this alliance, which has the collaboration of Sanofi, the Asociación Española de Pediatría de Atención Primaria (AEPap), the Sociedad Española de Inmunología (SEI), the Sociedad Española de Medicina de Laboratorio (SEMEDLAB), the Sociedad Española de Farmacia Hospitalaria (SEFH), the Sociedad Española de Directivos de la Salud (SEDISA), the Sociedad Española de Calidad Asistencial (SECA), and the Sociedad Española de Informática de la Salud (SEIS) also participate.
Key role of laboratory medicine
From SEMEDLAB, they have highlighted the relevance of laboratory medicine in the early detection of type 1 diabetes, since through a blood test it is possible to identify different autoantibodies linked to autoimmunity against pancreatic beta cells.
As has been detailed, the analytical panel related to type 1 diabetes includes the measurement of GADA, IA-2A, ZnT8A, and IAA, four markers of autoimmunity that recognize different components of the pancreas’s beta cells. Analyzing them together helps to know whether an autoimmune response has been initiated and to identify people who may be in an early stage of the disease.
"The laboratory has an important role because it makes it possible to detect these markers before symptoms appear. It is essential that the results are reliable and that they can be used to make decisions about confirming and monitoring each person," they stressed from the scientific society.
In addition to detection, the PAI sets out how to proceed next. In people in whom autoantibodies are identified, monitoring makes it possible to evaluate the progression of the disease and track its development, detecting the transition to the clinical phase, in which symptoms and hyperglycemia manifest.
With this approach, the aim is to reduce complications at the time of diagnosis, such as diabetic ketoacidosis, and to optimize care from the earliest stages.
"Detecting the disease earlier is an important step, but just as important is accompanying the person afterward. For that, we need well-defined follow-up and for all the professionals involved to work in a coordinated manner," they said from SEMEDLAB.