An Expert Discusses Screening and Monitoring for Type 1 Diabetes
With new type 1 diabetes screening technologies and monitoring guidelines available for populations at high risk, being prepared for a potential diagnosis is easier than ever before.
But is it recommended?
Is there such a thing as too much screening?
Are there any drawbacks to screening?
In this article we will discuss type 1 diabetes screening and monitoring guidelines for children.
We will also speak with Gary Scheiner, MS, CDCES, owner and clinical director at Integrated Diabetes Services.
What is the Importance of Screening for Type 1 Diabetes?
On December 11, 2023, the American Diabetes Association released its Standards of Care in Diabetes for 2024.
This year’s Standards of Care includes updated diagnostic criteria for type 1 diabetes to include antibody testing.
In the United States, as many as 60 percent of children are in diabetic ketoacidosis by the time type 1 diabetes is diagnosed. This is why Beyond Type 1 has been working to increase awareness of the condition and its warning signs.
Type 1 diabetes develops over many months on a continuum at different stages.
Unlike type 2 diabetes, type 1 diabetes is an autoimmune condition marked by the presence of beta-cell autoimmunity with two or more islet autoantibodies. These islet autoantibodies are proteins developed by the immune system in response to the body’s islet cells.
Who is Gary Scheiner?
Screening and monitoring children for type 1 diabetes is a tricky topic. So, we sat down to discuss the topic with Gary Scheiner, who has been in clinical practice since 1995.
Scheiner has lived with type 1 diabetes since 1985, and wanted to specifically create a practice for people living with type 1 diabetes of all ages.
They offer both in-person and virtual care.
Over the past 30 years, Scheiner has seen many cases of type 1 diabetes that run in families.
“I’ve seen all combinations of the type 1 diabetes family relationship: father/child, mother/child, adult child/older parent, and siblings,” says Scheiner. “Several families have multiple people with type 1 diabetes. Chances of developing type 1 diabetes go up about 10x when a 1st-degree family member has type 1 diabetes.”
Who Should Get Screened for Type 1 Diabetes and When?
There are currently no blanket recommendations for all children to be screened for type 1 diabetes. This is why it is crucial to get children screened if they have a family connection to the condition.
It’s always better to know what your—or your child’s—type 1 diabetes risk is. Diabetes autoantibody screening can detect markers of the disease months or even years before it develops.
Scheiner is a big advocate of type 1 diabetes screening for children of siblings who have the condition.
“It is empowering!,” says Scheiner. “If the test result is negative, parents can relax and just recheck in a couple of years. If the result is positive, many things can be done to delay or prevent type 1 diabetes development.”
Scheiner says that—at a minimum—blood-sugar monitoring will allow very early detection of elevated glucose levels and treatment. This prevents diabetic ketoacidosis at diagnosis, and can prolong the “honeymoon” for a long time.
This may be even more important because cases of type 1 diabetes are rising across the country, and researchers still don’t know why.
“There has been an increase in diagnoses among kids and adults,” says Scheiner. “Nationally, type 1 diabetes is increasing at a rate of approximately 3% per year.”
It can be tough to know when to screen kids for type 1 diabetes. Scheiner recommends that anyone, ages 2 and up, with a first-degree relative with type 1 diabetes be screened.
He adds that screening should be repeated every couple of years in kids.
Most adults can just screen one time and be fine.
Does Screening Guarantee a Type 1 Diabetes Diagnosis?
Does screening just reveal the inevitable?
Is everyone who gets screened—and is positive for autoantibodies—destined for a life with diabetes?
Unfortunately, Gary says this is usually the case.
“It is almost a certainty,” he says. “In fact, the presence of multiple islet antibodies is considered type 1 diabetes—with or without symptoms. The glucose levels have just not reached abnormal levels yet.”
Scheiner adds that this is “stage 1” of type 1 diabetes. From this stage, the chances of progressing to symptomatic type 1 diabetes—with high glucose levels—in 5 years is 44%.
In 10 years, it is 70%, and in 15 years it is 84%.
What Can You Do If Your Child Screens for Autoantibodies?
If your child screen positive for autoantibodies, Scheiner recommends that you not panic. Instead, he advises looking at the silver lining of early detection in time to do something about it.
He also advises seeing a professional right away.
“Work with a pediatric endocrinologist and/or certified diabetes care & education specialist who has expertise in early type 1 diabetes staging and intervention,” says Scheiner.
Several lifestyle strategies have the potential to slow the progression, and there are medications such as Tzield that are proven to help delay progression by several years.
Is it Possible to Overscreen Your Child for Type 1 Diabetes?
Scheiner says that there is little benefit to screening your child more than once a year.
Type 1 diabetes, he says, is relatively slow to progress from stage to stage—especially in older children.
However, Scheiner cannot think of any benefits to not screening.
“That is like putting your head in the sand,” he says. “Knowledge is power! We have several ways to preserve beta-cell function in those who test positive, so knowing whether the antibodies are present is empowering. Not knowing does a disservice to your child.”
Scheiner also acknowledges how scary it can be.
“I get it,” he says. “Nobody wants to know that their child may become ill. But, knowing that you can do something to delay or prevent it is so important.”
Years ago, we didn’t know enough about the various stages involved in type 1 development—or the mechanisms by which progression took place.
Times have changed!
“We may not have a cure or a vaccine, but we have effective tools for minimizing the impact of diabetes on all of our lives when it is caught early,” says Scheiner, who points out that catching type 1 diabetes before it is symptomatic can prevent being diagnosed with diabetic ketoacidosis.
Scheiner recommends checking for all 5 antibodies:
- GAD
- IAA
- IA2
- ICA, and
- Zinc Transporter.
He adds that most commercial labs offer these, as does TrialNet.
Empower Yourself with Knowledge
Getting screened can be scary, but it is empowering.
Scheiner recommends that we use this scientific breakthrough to our benefit to be best prepared for whatever the future may hold.
This content was made possible by Sanofi-Aventis, an active partner of Beyond Type 1.
Beyond Type 1 maintains editorial control over its content.
