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The estimated prevalence is 1 in 160,000 to 770,000 individuals worldwide. In these clinical guidelines, disorders caused by\n                    <jats:italic>WFS1<\/jats:italic>\n                    are referred to as\n                    <jats:italic>WFS1<\/jats:italic>\n                    -Wolfram syndrome, and those caused by\n                    <jats:italic>CISD2<\/jats:italic>\n                    as\n                    <jats:italic>CISD2<\/jats:italic>\n                    -Wolfram syndrome. Historically, it has been characterized by early-onset, antibody-negative, insulin-dependent diabetes mellitus, progressive optic atrophy, sensorineural hearing loss, arginine vasopressin deficiency, and brainstem and cerebellar atrophy. More recently, partial and late onset forms have been identified. There are currently no licensed disease-modifying treatments, and international clinical guidelines have not previously been established.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An international steering committee systematically reviewed 273 peer-reviewed publications and generated draft consensus statements across six clinical domains. These statements were evaluated by international specialists in endocrinology, clinical genetics, neurology, ophthalmology and neuro-ophthalmology, psychiatry, and urology, drawn from North America, Europe, Latin America, Oceania, and Asia, using a modified three-round Delphi process. Additional feedback was incorporated from nurses specializing in multidisciplinary Wolfram syndrome care, from leaders of international patient organizations, and from specialists in the genetic diagnosis of monogenic diabetes. Structured feedback from patients and families was gathered through multiple international patient advocacy organizations. Consensus was defined as \u226580% agreement.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All 35 final consensus statements reached the pre-specified consensus threshold of \u226580% agreement, spanning diagnosis and genetic testing, multidisciplinary care organization, neuro-ophthalmology, neurology, endocrinology, urology, gastroenterology, and psychiatry.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These guidelines are the first international clinical consensus for Wolfram syndrome and provide actionable recommendations for clinicians worldwide. Implementation should be accompanied by a prospective audit to expand the evidence base and support future iterations.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.02.26357130","type":"posted-content","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T22:20:16Z","timestamp":1783030816000},"source":"Crossref","is-referenced-by-count":2,"title":["Consensus Recommendations for the Clinical Management of Wolfram syndrome Using a Delphi Method"],"prefix":"10.64898","author":[{"given":"Josephine","family":"Elliott","sequence":"first","affiliation":[{"name":"Department of Cancer and Genomic Sciences, University of Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumel","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Yu-Wai-Man","sequence":"additional","affiliation":[{"name":"John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom"},{"name":"Cambridge Eye Unit, Addenbrooke\u2019s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom"},{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom"},{"name":"Institute of Ophthalmology, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gladstone","sequence":"additional","affiliation":[{"name":"The Snow Foundation, St. Louis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Gebel","sequence":"additional","affiliation":[{"name":"The Snow Foundation, St. Louis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Lynch","sequence":"additional","affiliation":[{"name":"Wolfram Syndrome UK, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Cancer and Genomic Sciences, University of Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9944-6293","authenticated-orcid":false,"given":"Fumihiko","family":"Urano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA"},{"name":"Department of Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"International Wolfram Syndrome Clinical Guidelines Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026070408400614000_2026.07.02.26357130v1.1","first-page":"715","article-title":"Diabetes mellitus and simple optic atrophy among siblings: report of four cases","volume":"1","year":"1938","journal-title":"May Clin Proc"},{"issue":"1","key":"2026070408400614000_2026.07.02.26357130v1.2","first-page":"6","article-title":"Wolfram Syndrome: Diagnosis, Management, and Treatment","volume":"6","year":"2016","journal-title":"Current diabetes reports"},{"key":"2026070408400614000_2026.07.02.26357130v1.3","doi-asserted-by":"publisher","DOI":"10.1038\/2441"},{"key":"2026070408400614000_2026.07.02.26357130v1.4","doi-asserted-by":"publisher","DOI":"10.1086\/520961"},{"key":"2026070408400614000_2026.07.02.26357130v1.5","doi-asserted-by":"crossref","unstructured":"Barrett TG , Bundey SE , Macleod AF . 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