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Type 1 diabetes (T1D) is a long-term condition where the immune system attacks and destroys beta cells in the pancreas. These cells are important because they make insulin, a hormone that helps control blood glucose levels.
Researchers found that certain factors, like genetic risks and environmental triggers, can cause the immune system to attack the pancreas. This attack begins with the development of a specific antibody, which leads to damage over time. As more beta cells are destroyed, blood glucose becomes harder to control, eventually causing diabetes. Insulin is the only treatment to manage blood glucose levels and allow the body to use glucose for energy.
Facts about T1D
How do type 1 diabetes and type 2 diabetes differ
Type 1 diabetes is chronic (long-term) condition where the immune system attacks and destroys beta cells in the pancreas. Anyone can get type 1 diabetes but it generally develops in children before age 10 years old. Type 2 diabetes is when the body is not able to use insulin properly due to insulin resistance leading to high glucose levels.
What is DKA?
Diabetic ketoacidosis (DKA) is a life threatening, medical emergency that occurs when glucose levels in the blood are very high because of lack of insulin. This causes buildup of ketones, which are a byproduct of fat breakdown that occurs when cells do not receive the glucose they need for energy. Buildup of ketones makes the blood more acidic and if left untreated, can lead to coma and even death. DKA can affect people with type 1 or type 2, but is more likely in those with type 1 diabetes. DKA is often a presenting symptom in type 1 diabetes mellitus (T1DM).
What are the symptoms of T1D and DKA?
Signs and symptoms of T1D include increased urination, increased thirst, increased hunger, sudden weight loss, and blurred vision. Signs and symptoms of DKA include all of the T1D symptoms plus nausea, vomiting, abdominal pain, constant fatigue, difficulty breathing, fruity breath, decreased attention and/or confusion.Â
If you or your child has any of the above symptoms then, call your health care provider office immediately or go to the nearest emergency room.
What is the screening for T1D?
Early detection has multifaceted benefits including timely diagnosis, understanding of the disease course and potential enrollment in prevention studies, reducing risk of diabetic ketoacidosis, and staging to understand the opportunity for treatment to slow or stop the disease progression.
Who qualifies for screening through organizations such as TrialNet:
- Ages 2 and 45 years and have a parent, brother/sister or child with T1D
- Ages between 2 and 20 years and have an uncle/aunt, cousin, grandparent, niece/nephew, or half-brother/sister with T1D
- Have not been diagnosed with diabetes
- Ages between 2 and 45 years and have tested positive for at least one T1D related autoantibodyÂ
MORE INFO ABOUT OTHER SCREEN OUTLETS/OPPORTUNITIES??
Provider Need to Know Info​
How to Screen – Two Parts
Screening for diabetes can be done through a small blood sample that is collected from an in-home testing kit or lab test at any Quest diagnostic or LabCorp.
The 2-hour oral glucose tolerance test (OGTT) (using 1.75 grams of glucose per kg of body weight up to 75 kg) is the gold standard to classify stage 1, 2, 3 type 1 diabetes. Characterizing the age-dependent effects of risk factors on type 1 diabetes progression.Â
At the time of diagnosis, over 90 percent of the patients with T1D have measurable antibodies against beta cell proteins including insulin, glutamate decarboxylase, islet antigen 2, zinc transporter 8, and tetraspanin-7. The progression of T1D disease course occurs in stages stage 1 is defined as normoglycemia with presence of 2 or more antibodies; stage 2 is dysglycemia with 2 or more antibodies and stage 3 carries the clinical diagnosis of T1D with 2 or more antibodies. There is 15 times increased risk of T1D in those with relatives of T1D. In addition, there is lifetime risk of developing T1D in the presence of two or more diabetes related auto-antibodies irrespective of having or not having a relative with T1D. The ADA published consensus screening and monitoring guidelines in children and adolescents up to ages 17 years.
- INCLUDE FIGURE 1 DIABETES CARE 2024 OR 2025 FROM DIABETES.ORG IF WE CAN GET PERMISSION OR LINK TO ADA PAGE
- Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes – American Diabetes Association (ADA)
How to Monitor
The ADA recommends that patients are generally monitored at 6 months and 12 months intervals, with the exception of children before 3 years of age with positive autoantibodies. These children are at a greater risk of progression and should be monitored more frequently, generally every 3 months.
- For patients with multiple autoantibodies, metabolic monitoring is done every 3 months due to 85% risk of disease progression.
- For patients with single positive autoantibody who revert to seronegative during the monitoring phase or do not progress then, education must be provided to them regarding diabetes and diabetic ketoacidosis symptoms.
- For patients with positive autoantibody status for 3 years, the monitoring includes yearly random glucose and HgbA1c testing for 3 years. If there is no progression after 3 years then, all antibody and glycemic monitoring can be discontinued with anticipatory guidance on risk of disease.
- If a patient has autoantibody with dysglycemia then, referral to a specialist center must be initiated for further management of type 1 diabetes with insulin.
How to Treat
Tepluzimab (TZIELD) is the first FDA approved medication that changes the progression of autoimmunity in T1D. It is a humanized immunoglobulin monoclonal antibody that binds to CD3. It is approved for use in children and adults >/= 8 years to delay onset of stage 3 type 1 diabetes.
For more information about treatment, view Standards of Care in Diabetes, 2025 from the ADA.
Additional Provider Resources
Diagnostic Panels
- Labcorp Diabetes Autoimmune Panel –Â 504050: Diabetes Autoimmune Profile
- Quest Diagnostics Diabetes Autoimmune Panel – Â Diabetes Type 1 Autoantibody PanelÂ
Micro-learning and Continuing Education
- NAPNAP TeamPeds Experts Live – Mili Vakharia, MSN, APRN, FNP-C, CDCES addressing T1D
- ADA On Air podcast, Dr. Albanese-O’Neill and Dr. DiMeglio on guidance for monitoring islet autoantibody–positive pre-stage 3 type 1 diabetesÂ
- Screen to Prevent Type 1 Diabetes – Stop Type 1 Diabetes, includes education module with CME for HCPs
Key Resources from T1D Organizations
- Trial Net – international network of researchers who study T1D aiming to prevent, delay and reverse the progression of the disease.Â
- T1D Toolkit – ADA
- Provider Resources – Getting Ahead of Type 1Â
T1D Provider Pocket Guide
Coming soon!
Patient Need to Know
Content/intro?
Resources for Patient Families
NAPNAP experts have curated easy to understand resources from reputable organizations and sources.
- Diabetes and School Health (DASH) Program – Nationwide Children’s Hospital
- Family Tools – Stop Type 1 Diabetes
- Screen it Like You Mean It Ways to Screen English and Spanish – Screen For Type 1
- Early Detection & Screening Options – Breakthrough T1DÂ Â
- Â Support and Empowerment Community – The Diabetes Link for Young Adults
- Ask The Experts: Where to turn when your patient or child has screened positive for type 1 diabetes- Barbara Davis CenterÂ
- Patient Resources – Getting Ahead of Type 1 Diabetes
- Caregiver Resources – Getting Ahead of Type 1 Diabetes
Hear from Our Expert
NAPNAP’s [Name/credentials] shared important information with providers and patients in an audio news release. Â
Audio clip coming soon!