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Martens, P.* ; Vercauteren, J.* ; Ziegler, A.-G. ; Overbergh, L.* ; Mathieu, C.*

Screening for early-stage type 1 diabetes mellitus.

Nat. Rev. Endocrinol., DOI: 10.1038/s41574-026-01323-z (2026)
DOI
Open Access Green as soon as Postprint is submitted to ZB.
Type 1 diabetes mellitus (T1DM) is now recognized as an autoimmune disease that evolves through distinct presymptomatic stages, often for years before the onset of hyperglycaemia and the need for insulin therapy. This presymptomatic period creates opportunities for early detection, with the presence of two or more islet autoantibodies (IAbs) defining early-stage, presymptomatic T1DM. Identification of T1DM during this presymptomatic window enables metabolic follow-up and education, thereby reducing the risk of diabetic ketoacidosis at diagnosis while facilitating psychological adaptation, timely access to disease-modifying therapies and participation in clinical trials. Current approaches for identifying early-stage T1DM range from IAb screening of individuals at high risk to screening of the general population, each with distinct advantages and implementation challenges. In this Review, we discuss the rationale for screening, compare screening strategies, examine current implementation initiatives and highlight key clinical, logistical, economic and ethical considerations for large-scale implementation in routine health care. We also consider unresolved challenges, including cost-effectiveness, equitable access to follow-up care and disease-modifying therapies, and harmonization of care pathways, as successful implementation of T1DM screening will ultimately depend not only on scientific advances but also on sustainable integration into health-care systems, marking a shift from reactive treatment towards preventive care.
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Publication type Article: Journal article
Document type Review
ISSN (print) / ISBN 1759-5029
e-ISSN 1759-5037
Journal Nature Reviews - Endocrinology
Publisher Nature Publishing Group
Publishing Place New York, NY
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research (IDF)