Observational studyDiabetologia2025
Prevention of diabetic ketoacidosis in relatives screened for islet autoantibodies and followed up in the TrialNet Pathway to Prevention study at a single institution in Italy.
Observational study in Diabetologia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00097292 (TrialNet Pathway to Prevention of T1D), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
TrialNet Pathway to Prevention of T1D
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Polish Recommendations for the Early Detection of Type 1 Diabetes in the Pediatric Population: A Position Statement of the Polish Society of Pediatric Endocrinology and Diabetology and the Pediatric Section of the Diabetes Poland 2026.Hormone research in paediatrics · 2026Guideline
- International consensus guidance for general population screening for islet autoantibodies to diagnose early-stage type 1 diabetes: a nominal group technique process.Diabetologia · 2026Article
- Article
- Reducing Diabetic Ketoacidosis in Pediatric Type 1 Diabetes: The Impact of Screening Programs and Early Disease-Modifying Treatment.Journal of clinical medicine · 2026Review
- Screening and Monitoring for Presymptomatic Type 1 Diabetes: A Time for Action.Hormone research in paediatrics · 2026Review
- An international consensus on screening and monitoring early-stage type 1 diabetes: A roadmap to European implementation.Diabetes, obesity & metabolism · 2026Review
- Article
- Early Detection of Pediatric Type 1 Diabetes: The Expanding Role of Screening.Children (Basel, Switzerland) · 2026Review
- Optimizing Type 1 Diabetes Screening in People With Family History: A German Perspective.Journal of diabetes science and technology · 2025Review
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aims/hypothesisScreening for islet autoantibodies is an effective method for identifying individuals with pre-symptomatic (stage 1 and 2) type 1 diabetes. This approach offers a valuable opportunity for education and monitoring, which can help to reduce the severity of clinical manifestations at clinical onset (stage 3), including diabetic ketoacidosis. The aim of the study was to evaluate the progression to stage 3 and the incidence of diabetic ketoacidosis in relatives of individuals with type 1 diabetes screened and followed up at a single institution in Italy.
methodsThis was a single-centre observational study conducted at San Raffaele Hospital, Milan, Italy, within the international multisite TrialNet Natural History Study-Pathway to Prevention. First-degree (aged 1-45 years) and second-degree (aged 1-20 years) relatives were screened primarily for GADA, IAA and IA-2A. In the event of a positive result, subsequent testing was conducted for ICA and ZnT8A. Periodic autoantibody testing, metabolic monitoring and educational support were offered to all autoantibody-positive participants. Participants were screened between July 2005 and February 2020, with the latest update obtained between January 2023 and June 2024.
resultsIn total, 4046 relatives were screened at a median (IQR) age of 17.6 (7.9-38.0) years. At first screening, 4.9% were found to be positive, with 3.1% having a single autoantibody and 1.8% multiple autoantibodies. Follow-up data were available for 78.5% of the participants, with a median (IQR) follow-up time of 9.9 (6.5-13.5) years. Progression to stage 3 was observed in 51 (1.6%) participants. Disease onset occurred in 0.4% of autoantibody-negative, 6.5% of single-positive and 43.1% of multiple-positive participants after a median (IQR) time of 7.8 (5.4-10.4), 7.9 (2.1-11.8) and 2.9 (0.9-6.5) years, respectively (p=0.012). The Kaplan-Meier survival free of clinical diabetes at 15 years was 99.5% (95% CI 99.1, 99.7), 87.3% (95% CI 74.4, 94.0) and 45.9% (95% CI 31.1, 59.6), respectively (p<0.001). At the time of disease onset, no occurrences of diabetic ketoacidosis were documented. Median (IQR) HbA CONCLUSIONS/
interpretationThe early identification of individuals at risk for type 1 diabetes through a single-centre approach, combining autoantibody screening and regular monitoring, completely prevented diabetes-associated ketoacidosis at disease onset in relatives of individuals with type 1 diabetes.
trial registrationClinicalTrials.gov NCT00097292.
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