Early detection of type 1 diabetes can be a game-changer, but are we doing enough? Dr. Shara Bialo, a pediatric endocrinologist and a person living with type 1 diabetes, sheds light on the crucial role of early screening during American Diabetes Month. She emphasizes the benefits of catching type 1 diabetes (T1D) early, which can prevent life-threatening complications and give patients and families time to prepare. But here's where it gets controversial: despite growing awareness, widespread screening isn't yet the norm. Let's dive in.
Dr. Bialo points out that approximately 64,000 people are diagnosed with type 1 diabetes annually, with a significant portion being adults – a common misconception. In children, T1D often presents as diabetic ketoacidosis (DKA), a critical condition where the body can't use glucose and starts burning ketones for energy. This is also common in adults, though less frequent than in children, and can be life-threatening. Early screening allows for intervention with education and preparation, potentially eliminating DKA at the onset.
Dr. Bialo stresses that early detection offers the priceless gift of time. Imagine being diagnosed in a crisis, like experiencing DKA and ending up in a coma. This leaves little time to understand the disease and absorb the information needed to manage it. Early detection allows families to prepare clinically and psychologically for insulin therapy, which can be a huge relief.
So, why isn't autoantibody screening standard practice? Dr. Bialo highlights several barriers. One major hurdle is clinician awareness, including understanding the three stages of type 1 diabetes, how to order and interpret autoantibody tests, and navigating cost and reimbursement. Logistical and workflow constraints in daily clinical care also play a role.
And this is the part most people miss: concerns about patient anxiety. While some worry about the psychological impact of uncovering an asymptomatic condition, data shows that people fare better in the long run when they have time to prepare. The field is evolving, with clearer guidelines on managing patients with autoantibody positivity. The American Diabetes Association recommends screening those at high risk, such as individuals with a family history of T1D (up to 15 times increased risk) and those with autoimmune diseases. The ultimate goal is general population screening, as 90% of new-onset cases have no family history.
Pharmacists and other care team members can play a vital role. They can identify potential candidates based on family history, symptoms, and medications, providing education about the risks. Repeating the message from multiple sources, such as pharmacists and primary care physicians, reinforces the importance of screening.
What are your thoughts? Do you think the current screening practices are sufficient, or do we need to do more to improve early detection of type 1 diabetes? Share your opinions in the comments below!
