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T1D Antibody Screening: Identifying High-Risk Populations
Following audience polls, the panelists provide clinical insights into their screening practices for patients with type 1 diabetes, highlighting key antibodies they screen for.
The following is a summary of the video transcript and has been edited for length and clarity.
Goldman: Let’s talk about screening, now, which can help avoid that crisis. Who is at high risk? How should we screen?
Burton: The first group to think about are those with a first degree relative with type 1 diabetes. When you’re taking a family history or seeing a new patient on follow-up, just ask, “Do you have any type 1 diabetes in your family?” Anyone who answers “yes” needs to be screened. We also need to screen anyone with a history of autoimmune disease such as Hashimoto thyroid disease, celiac disease. We need to remember, too, that it’s not only children at risk. We know that 1 in 300 children will develop type 1 diabetes, but the incidence peaks in between ages 10 and 14, and again in young adulthood, between ages 20 and 30. Overall I would say if you see somebody in clinic with dysglycemia, blood glucose in the pre-diabetes range, it does not hurt to check for type 1 diabetes antibodies.
Goldman: Staying on the topic of screening, what antibody tests specifically should we be ordering? If we're in primary care what should we be doing?
Shenkman: There are 4 autoantibodies to screen for (Figure 1). They are insulin autoantibodies, glutamic acid decarboxylase autoantibodies, insulinoma-associated-2 autoantibodies and zinc transporter 8 autoantibodies. If a person screens positive for 2 or more antibodies, their risk of developing type 1 diabetes over 10 years is about 70%. Their lifetime risk is 100%. You always want to confirm with a repeat laboratory test anyone who has positive antibodies; even if there is only 1, we still want to monitor for progression. This is where our primary care and pediatric colleagues can help, by doing this type of screening. As we said, we don’t see the whole family, the siblings of our patients who have type 1. If we can start screening more proactively, we'll be able to catch these patients sooner to delay progression to stage III.
Man With Newly Diagnosed Type 2 Diabetes: What HbA1c Goal-And How to Get There?
May 8th 2013The patient, an active 49-year-old man, had an HbA1c of 8.6 after diabetes was first diagnosed. It’s now 7.6 with metformin and lifestyle measures. Is the current A1c goal adequate, or should you treat more aggressively?
