![]() Our hope as pediatric endocrinologists and endocrinologists is that there might be an investment in the future to do a population screen. Even when a patient has a random elevated blood sugar but not be what we define as stage III-a stage where insulin therapy is needed-that patient should be screened with antibodies. Certainly, we screen first-degree relatives, but we also need to talk with pediatricians to come up with strategies. Therefore, it’s important that we also put in perspective the situation of patients who travel hundreds of miles to get there, and to make this available. ![]() As we talk about these topics, we have to realize that not all the patients have access to diabetes centers with a team of people. ![]() They can be tested as part of an effort that’s supported by the National Institutes of Health, or they can be tested commercially for the presence of these antibodies.Īdditionally, TrialNet provides kits that can be sent to the family. Especially now that there’s an option to intervene, they should absolutely be tested. We’ve been screening actively in many diabetes centers around the country for people who are deemed to be at high risk because they already have a relative with type 1 diabetes. For many years, there has been an effort supported by NIH, and many other organizations, called TrialNet. There are reports of a higher incidence than 1 in 400. Teresa Quattrin, MD: There are data that show that the incidence is increasing. You’re certainly not going to screen 400 people, so whom would you home in on? The incidence of type 1 is about 1 in 400 children. Robert Busch, MD: Dr Quattrin, which patients do you screen for type 1 diabetes? Whom would you choose to screen? You’re not going to screen every patient. There’s a lot to learn about how to interpret those, but they’re widely available, and there are research studies widely available for people to have those antibodies measured. What’s hard is that the antibodies that have been used historically to develop all the data on risk of progression are the same methodology we might get in clinical practice. What’s great is that they’re all available commercially. There are 4 major biochemical antibodies: GAD, IA-2, insulin, and zinc transporter 8. What’s exciting is that there’s a test that we can do earlier in that disease process, while the disease is still clinically silent, that measures IDA autoantibodies, or type 1 diabetes–associated antibodies. Most people are diagnosed at stage III because it’s a silent disease, until the end, when the beta cells are under an intense amount of stress. Classically, those are the ways we would diagnose stage III, or type 1 diabetes. To diagnose, you must have elevation of a fasting glucose, an elevation on a 2-hour oral glucose tolerance test, an elevated hemoglobin A1C, or a random glucose that’s elevated with symptoms. If it’s not an urgent situation, often we’ll send a hemoglobin A1C, but we know from the American Diabetes Association that the standard diagnostic criteria are a little different from that. In the office, if the pediatrician is concerned, most of the time they’re checking the urine for glucose or ketones or giving a random blood glucose if they have that available. To do that, we can’t use the tests that we’ve been using all these years. Kimberly Simmons, MD, MPH/MSPH: Dr Goland talked about being able to intercede earlier. How are they tested for this? What are the standard tests that you might do? Robert Busch, MD: Dr Simmons, how are patients tested for type 1 diabetes? Dr Robin Goland mentioned stage III, when they have clinical diabetes.
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