Screening Guidelines for Type 1 Diabetes
Panelists discuss early testing with autoantibody screening for type 1 diabetes in at-risk individuals, particularly those with family history or genetic predisposition, to avoid DKA at diagnosis and allow time for patient and family preparation.
The following transcript has been edited for clarity and length.
Javier Morales, MD: So, what about screening and awareness, Shira?
Shira Eytan, MD: Screening for type 1 diabetes is a relatively new concept, but the American Diabetes Association has issued guidelines supporting it. Early screening, paired with consistent monitoring and education about the signs and symptoms, can prevent patients with early-stage type 1 from developing diabetic ketoacidosis (DKA). This reduces emergency room visits, hospitalizations, and even deaths associated with stage III diabetes, which has traditionally been when most of our patients were diagnosed. Screening for autoantibodies also helps identify patients misdiagnosed as having type 2 diabetes—about 40% of adults over the age of 30 with type 1 are initially misclassified. This misdiagnosis often stems from the misconception that type 1 is a childhood disease, but we know it can develop at any age. We see now that just being able to give patients and families the information that the autoantibodies discovered in a blood test means that they are at risk for type 1 diabetes allows them some time to prepare, reduces stress at diagnosis, and improves long-term outcomes.
Morales: I think we should acknowledge that there is some bias in screening, especially around body mass index.
Eytan: Absolutely. It’s not as clear-cut as we might think or how we traditionally viewed type 1. People often associate type 1 with young, lean patients, but type 1 can occur in individuals of any weight. Overweight or obese patients, as well as adults, can develop type 1. It’s important to maintain a low threshold for screening to catch those at risk.
Morales: A question to our audience: are you aware that type 1 diabetes progresses through distinct stages? Please answer yes or no. Quentin, do these stages apply to pediatric patients as well?
Quentin Van Meter, MD: Absolutely. As Dr Robertson mentioned earlier, there’s a large population of undiagnosed individuals. While first-degree relatives of type 1 patients are at higher risk, 90% of new type 1 cases occur in people without a family history. Broader screening would help us identify those progressing through earlier stages before they reach stage III. This could reveal more about the prevalence of early-stage type 1 in the general population.
Morales: It’s encouraging that many in the audience recognize the stages of type 1 progression. Let’s take it a step further: how confident are you in defining these stages?
Bethany, what’s your experience with primary care colleagues’ understanding of this?
Bethany Kinsey, NP: It’s still not common knowledge, but we are all working on building awareness. I’ve worked with primary care nurse practitioners in my area to educate them about screening for autoantibodies. They’ve started identifying patients and referring them to endocrinology, which is exciting because early detection allows us to provide education and treatment sooner. But I think primary care providers are still going to play a critical role in finding these patients before they ever reach specialists.
Morales: Based on the poll, there is a wide variety of responses but most of our audience feel at least somewhat confident in their ability to define these stages of type 1 diabetes.
