ISPAD Rio 2026 — Triagem voluntária

1. About This Screening

You are invited to participate in a voluntary screening to identify risk factors for Type 1 Diabetes (T1D) during the ISPAD 2026 conference. This screening does not replace a medical evaluation or diagnosis. This screening uses the Dried Blood Spot (DBS) fingerprick sample analyzed using the ADAP methodology to test four autoantibodies associated with T1D: anti-GAD, anti-IA2, anti-IAA, and anti-ZnT8.

This is a screening initiative for educational and awareness purposes. It is not a clinical diagnosis. A definitive diagnosis should not rely on the results of a single test and should be made by a physician considering all clinical and laboratory findings in the context of your overall clinical picture.

The services performed under the BR1DGE DIAGNOSTICS Program are funded by Sanofi and comply with national and international quality guidelines, being considered the most appropriate for identifying changes and monitoring pre-existing conditions.

A licensed healthcare provider must order this test, and they or their designee will explain the purpose, potential benefits, risks, and limitations of the islet autoantibody test before the sample is collected.

A positive result may indicate an increased risk of developing T1D but does not guarantee the onset of the disease. This test detects autoantibodies related to T1D only and does not serve as a diagnostic test for diabetes.

This screening is part of the BR1DGE Diagnostic Support Program (DSP), sponsored by Sanofi Medley Farmacêutica Ltda. (“Sanofi”) and operated through the Program portal available at sanoficonecta.com.br.

The Program is responsible for subsidizing beta-cell autoantibody tests for patients at risk of autoimmune diabetes mellitus, in accordance with the Program regulations, which are subject to change without prior notice. Any other necessary measures, including, but not limited to, additional tests not available through the Program, medical consultations, hospital admissions, urgent and emergency care, therapeutic or interventional procedures, nursing services, administration of medications outside the scope of the Program, and treatments related to complications or adverse events, are not the responsibility of Sanofi, considering the nature of the Program.

If you have any questions, you may contact the Program by calling 0800 (toll-free throughout Brazil, Monday through Friday, from 9:00 a.m. to 6:00 p.m., except on national holidays), through the Program’s official WhatsApp account using the same number, or by email at bridgediagnosticos@sanofi.com.

2. Participant Information

Please provide the following information. This data is required to process your sample, deliver your results, and comply with applicable privacy regulations.

Full name

Date of birth (DD/MM/YYYY)

Email address

Telephone

Country of residence

Preferred language for results

PortugueseEnglish

Is the individual (as they are no yet patients) a physician (MD or DO only)?

YesNo

Sex assigned at birth

MaleFemale

3. Health Questionnaire

All answers are confidential and serve as orientation for your screening results interpretation.

4. Roles & Responsibilities

5. About the Test & Your Results

6. Data Protection & Privacy

7. Transparency Disclosure

8. Financial Responsibility & Compliance

9. Consent

Please read the statement below carefully and check the box to confirm your agreement.

I have read and understood the information above, and I voluntarily consent to participate in this screening under the terms described, including data collection, sample processing, international transfer, and result delivery. I acknowledge my rights under LGPD. I confirm that I have had the opportunity to ask questions, which have been answered to my satisfaction. I understand that choosing to participate or decline will not affect my access to healthcare services.

I expressly authorize the performance of the test(s) as requested by my physician or by me, in accordance with the terms of this consent form.

I hereby acknowledge that the collection of biological samples (fingerstick for obtaining dried blood spot samples — DBS) involves inherent risks, including, but not limited to, discomfort, local bleeding, and other complications inherent to the procedure, as well as the possibility of error, loss, or delay in the analysis or delivery of results. I declare that my participation in this Program is entirely voluntary and at my own risk, having been previously informed about the nature, purpose, and limitations of the screening, as described in this Consent Form. I further acknowledge that I am responsible for seeking appropriate medical follow-up and for any resulting costs, if necessary. In view of the foregoing, I release Sanofi, its affiliates, directors, employees, and contracted partners from any liability or obligation to indemnify related to my participation in this Program, including, but not limited to, any material, moral, or other damages of any nature.

Physician identification

The responsible physician must sign below. The signature is equivalent to accepting this form.

Physician full name

Title/Specialty

Institution Name

Practice Address

Medical ID Number / National Provider Identifier

Physician email

Physician signature

Sign in the box below