Type 1 diabetes (T1D) is a chronic (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. Without insulin, glucose cannot enter the cells, be utilized for energy and, instead builds up into blood vessels.
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 specific antibodies, which lead to damage over time. As more beta cells are destroyed, blood glucose becomes harder to control, eventually causing diabetes. In patients with type 1 diabetes, insulin is the only treatment to sustain life and manage blood glucose levels.
Facts about T1D
How do type 1 diabetes and type 2 diabetes differ?
There are many different types of diabetes and appropriate diagnosis can help with the right treatment.
- Type 1 diabetes is a 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. Children ages 10 and above or those in puberty generally develop type 2 diabetes.
What is DKA?
Diabetic ketoacidosis (DKA) is a preventable, 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.Â
Signs and symptoms of DKA include: all of the above 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, call your healthcare provider’s office immediately or go to the nearest emergency room.
Why is screening needed?
Early detection has multifaceted benefits, including timely diagnosis, understanding of the disease course and staging to potentially enroll in prevention studies for treatment to slow or stop the disease. More importantly, it helps reduce the risk of diabetic ketoacidosis.
What is the screening and genetic risk for T1D?
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 three stages:
- Stage 1 is defined as normoglycemia with the presence of 2 or more antibodies;
- Stage 2 is dysglycemia with 2 or more antibodies
- Stage 3 carries the clinical diagnosis of T1D with 2 or more antibodies.
There is a 15 times increased risk of T1D in those with relatives of T1D. In addition, there is a 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. In 2024, the ADA published early screening and monitoring guidelines for children and adolescents up to age 17 years.
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
Provider Need to Know Info​
How to ScreenÂ
Screening for diabetes autoantibodies 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. Testing can be done by primary care providers.
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 for classifying stage 1, 2, and 3 type 1 diabetes. Characterizing the age-dependent effects of risk factors on type 1 diabetes progression.
- See Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes – American Diabetes Association (ADA)
- Graphic abstract below. For larger view, click here.
How to Monitor
The ADA recommends that patients are generally monitored at 6-month and 12-month 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.
How to Treat
For patients with positive autoantibodies only:
- 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 patients with positive autoantibodies, diabetes symptoms and/or dysglycemia:
- Refer to diabetes center immediately for further management and initiation of insulin.
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 –  Diabetes Type 1 Autoantibody Panel
Micro-learning and Continuing Education
- NAPNAPÂ TeamPeds Experts Live –Â 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
The T1D Pocket Guide was developed by NAPNAP for providers and patients to have access to basic information about type 1 diabetes. Download the full guide here or by clicking the image to the right.
T1D Awareness Campaign
Patient Need to Know
Finding out your child is at risk for diabetes can be stressful and overwhelming for your family. But don’t worry—your child’s health care team, including nurse practitioners and pediatric endocrine specialists, are here to help. They have the latest research and guidelines to give you the best advice and support. If you have any questions, ask your child’s provider to explain the diagnosis and treatment plan in a way that is easy to understand.
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
NAPNAP’s T1D awareness social media campaign aims to protect vulnerable patients by ensuring providers, patients, and parents are well-informed. NAPNAP member experts helped us explore different topics, such as early detection, monitoring and treatment strategies pertaining to pediatric T1D.
Increasing T1D Screening Awareness
English Audio News Release
Spanish Audio News Release – Coming Soon
