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 T1D Information for 
  PROVIDERS 

 WHY screen  my patients for pre-symptomatic T1D?

 HOW do I screen  my patients for pre-symptomatic T1D?

 WHAT are the stages  of Type 1 Diabetes?

Result: Screened  POSITIVE  

Result: Screened  NEGATIVE  

 WHY screen  my patients for pre-symptomatic T1D?

In type 1 diabetes (T1D), the immune system destroys cells in the pancreas that make insulin. Insulin helps us use the energy from foods we eat. A person living with T1D needs lifelong daily insulin injections to stay healthy. Screening for T1D with a blood test for T1D associated antibodies (islet autoantibodies) can identify individuals who are at high risk of developing T1D and can prevent children from getting very sick.

 

1.  National and international consensus guidelines recognize T1D before symptoms develop.

In 2015, the American Diabetes Association, JDRF, and Endocrine Society released T1D STAGING GUIDELINES based on islet autoantibody status and glycemic status in an effort to identify pre-symptomatic disease. The presence of multiple islet autoantibodies is associated with a 44% 5-year risk and a 70% 10-year risk of clinical T1D. Without an effective intervention, the presence of multiple islet autoantibodies is considered a ‘point of no return’ as there is a lifetime risk of T1D development approaching 100% . Early detection allows prevention of diabetic ketoacidosis (DKA) at diabetes onset and provides patients and their families with opportunities to participate in interventions and clinical trials that may delay or prevent disease. The 3 stages are as follows (click to enlarge):

2.  Most children with T1D (90%)  DO NOT have a family member with T1D.

T1D-associated autoantibodies are identified in over 1% of children in Colorado. Although children who have a family member with T1D have a 15-20X increased risk of developing T1D, the large majority of children diagnosed with T1D (90%) do not have a family history of T1D. Because the clinical symptoms of T1D overlap with common pediatric illnesses, T1D is often unrecognized in families who are not familiar with T1D signs and symptoms.

3.  Screening for T1D and monitoring patients who screen positive over time can prevent diabetic ketoacidosis (DKA) and may improve long term glycemic control.

The rate of diabetic ketoacidosis (DKA) at the time of T1D onset is increasing over time throughout the U.S. Although rates vary across the United States, in Colorado 58% of children diagnosed with T1D present in DKA. DKA is life threatening and associated with complications such as cerebral edema, memory and cognitive defects and worsened long-term glycemic control, thereby increasing the risk for vascular complications. An estimated 120 children in the U.S. die every year as the result of a delayed diagnosis of T1D. Children detected by screening for T1D associated antibodies rarely progress to DKA. Prior studies at the Barbara Davis Center, including the TEDDY and DAISY studies have shown that 90% of children who know they have the T1D associated antibodies and are connected with a healthcare team for routine metabolic monitoring avoid DKA at onset of diabetes. 

4.  T1D Prevention trials may be available if your patient screens positive. 

 

 HOW do I screen  my patients for pre-symptomatic T1D?

There is only one set of markers in the blood — islet autoantibodies: GADA, IA-2A, insulin antibody, ZnT8A, ICA — that are associated with the development of type 1 diabetes (T1D). Clinical, consumer and research labs measure T1D associated antibodies (and/or celiac antibodies), and there are several screening programs available in the United States.


To determine the best way to screen your patient for T1D risk, please email us at Questions@ASKhealth.org or call 303-724-1275. We will guide you through choosing the screening lab or program listed below that is the best fit for your patient. Or if your patient has already been screened and you would like help determining the next steps, please email or call, and a member of Ask the Experts will reach out to you.

VIEW / DOWNLOAD (PDF) Chart of U.S.-based Screening Programs/Laboratories

 

 WHAT are the stages  of Type 1 Diabetes?

T1D-STAGES.png

  2h-PG = 2-hour plasma glucose  /  FPG = fasting plasma glucose  /  RPG = random plasma glucose

ADA Standards of Medical Care in Diabetes: In absence of unequivocal hyperglycemia,
  diagnosis requires 2 abnormal test results from same or separate samples

 

Result: Screened  POSITIVE  

Please check a blood glucose level and a hemoglobin A1C to determine glycemic status and rule out a diagnosis of diabetes. A positive screening test needs to be confirmed by measuring all four T1D-associated antibodies (GAD-65 antibody, IA-2 antibody, insulin antibody, ZnT8 antibody). These antibodies should be measured from serum in a CLIA-approved reference laboratory. Ideally, the lab should be an active participant in the Islet Autoantibody Standardization program.

 

If you need help determining how or where to order a confirmation blood test for type 1 diabetes associated antibodies, please provide your name, phone number and email address below.

 

If your patient screened POSITIVE and confirmed POSITIVE, your patient should be monitored for progression to type 1 diabetes.
 

Please provide your name, phone number and email address — and an Ask the Experts team member will contact you to help determine the best way to care for your patient and provide helpful resources.

 

We aspire to build a network of “Local Experts”. If you want to partner with Ask the Experts so that we can refer patients with early T1D in your area to you for education and metabolic monitoring, please check the box below.

Please provide YOUR NAME, EMAIL and PHONE
and Ask the Experts will contact you.            

Thanks for submitting!

 

Result: Screened  NEGATIVE  

A negative autoantibody result does not mean a person will never develop T1D.

We recommend re-screening for T1D associated antibodies based on the patient's personal and family history of autoimmune diseases, as shown below:

  • PERSONAL HISTORY
    of autoimmunity; and/or

     

  • FAMILY HISTORY of autoimmune disease

CONSIDER REPEAT SCREENING
ANNUALLY

  • NO PERSONAL HISTORY 
    of autoimmunity; and

     

  • NO FAMILY HISTORY
    of autoimmune disease

For AGE <15yrs:

  • Repeat at recommended intervals as appropriate: 1-3, 4-6, 7-13 yrs

  • Repeat at ANY age if symptoms of hyperglycemia (also check glucose level and HbA1c)

 

 NEXT STEPS:  

 

If you have questions about:

  1. Interpreting screening results; or

  2. Determining a follow-up plan after receiving results; or

  3. Screening for type 1 diabetes or celiac

 

Please e-mail us at Questions@ASKhealth.org or call us at 303-724-7983 and a member of Ask the Experts will reach out to you.