Referral and Screening for Progression
Panelists discuss how delaying intervention between stage II and stage III T1D can result in irreversible β-cell loss, higher rates of complications, and poorer overall outcomes for patients.
The following transcript has been edited for clarity and length.
Javier Morales, MD Let’s pose a question to our audience: To whom do you typically refer patients for confirmation of progression from stage 2 to stage 3 type 1 diabetes and for specialized management? Please select all that apply.
Abha, in your clinical practice, I’m sure you’ve encountered many patients presenting with DKA right from the start. Can you share your insights?
Abha Choudhary, MD: Certainly. In our practice, we manage approximately 2,500 children and see 300 new cases of type 1 diabetes annually. Alarmingly, nearly half present in DKA—many with severe complications requiring ICU admission, such as low pH, altered mental status, or cerebral edema. These patients need insulin drips and IV fluids, and it’s a major challenge to manage.
Our wards are often full, and reducing the incidence of DKA is a priority. Studies show that proper screening and monitoring can lower the DKA rate to under 5%. This highlights the importance of early detection and intervention.
Morales: Looking at the poll responses, it’s no surprise that most referrals go to endocrinologists or pediatric endocrinologists. However, diabetes management is highly complex and often relies on a multidisciplinary team, including diabetes specialist nurses.
These nurses are incredibly skilled, frequently updating their knowledge at conferences and excelling in technological adaptations. That said, many areas lack access to endocrinology services, leaving primary care providers—both pediatric and adult—to shoulder this responsibility.
Here’s another question for the audience: How often do you screen primary populations for type 1 diabetes stage progression during routine appointments? Please select your answer.
Choudhary: Dr. Morales, another challenge is the shortage of endocrinologists. Recruitment into fellowship programs has been difficult, and our next available appointment for new patients is often a year out.
To address this, we’ve established a screening clinic staffed by mid-level providers and an MD, allowing us to fast-track antibody-positive patients within a week. This has been crucial for timely care.
Morales: That’s impressive. Let’s see what the audience has to say about screening practices. The responses are split—about 50% rarely screen for progression, and the other 50% occasionally screen.
This underscores the need to emphasize the importance of screening. Here’s another question for the audience: Why is screening for type 1 diabetes stage progression important? Is it:
- To detect early signs of disease progression and intervene?
- To tailor treatment strategies based on disease stage?
- To mitigate long-term complications?
- All of the above?
Screening is undeniably vital.
Choudhary: Screening not only enables early intervention but also creates opportunities for research participation. This is critical as we work to improve treatment options and outcomes.
Morales: Absolutely. And as you mentioned earlier, the shortage of endocrinologists is concerning, but it’s also an exciting time for technology-driven innovations in diabetes care. For anyone interested in technology and healthcare, this field offers incredible opportunities to make a difference.
Let’s see the poll results. As expected, most of the audience agrees: all of the above are compelling reasons to screen for disease progression. This aligns with our mission to improve outcomes through early detection and comprehensive management.
