Managing adults with screen-detected islet autoantibody positivity: a pragmatic framework

New disease-modifying therapies, such as teplizumab, offer opportunities to delay the clinical onset of type 1 diabetes but require islet autoantibody screening to identify individuals at increased risk of progression to diabetes. As type 1 diabetes screening programmes expand, clinicians will increasingly encounter a new group of people: adults who test positive for islet autoantibodies but have not yet been diagnosed with diabetes. Although international guidelines outline management for both children and adults, considerable uncertainties remain, particularly for adults. In adults with islet autoantibody positivity, the lower risk of progression to type 1 diabetes compared with children, combined with the high background prevalence of mild non-autoimmune dysglycaemia, presents substantial challenges for clinical management. This Personal View aims to add clarity to international consensus guidelines, proposing a pragmatic framework for managing adults with islet autoantibody positivity. Although fitting within a UK National Health Service setting, we feel this framework is also relevant to other health systems.