A diagnosis of type 1 diabetes does not have to be a crisis.
Screening for type 1 diabetes (T1D) autoantibodies can detect the disease in its earliest stages.
Why Screen?
- Prevent diabetic ketoacidosis (DKA)
- Avoid misclassification as type 2 diabetes at diagnosis
- Help individuals and families better prepare for a potential diagnosis
- Provide people with the opportunity to participate in research trials
The Role of the Beta Cell
In T1D, the immune system gets ‘confused’ and mistakenly attacks the insulin-producing beta cells in the pancreas, which leads to a decline in beta cell number and function over time. Although beta cells are best known for making insulin, they also have the vital role of maintaining glucose homeostasis, impacting a range of the body’s organs and systems.
Detection of at least 2 or more islet autoantibodies (AAbs) through screening is a sign that the immune system attack on beta cells has begun.
The Hidden Progression of Type 1 Diabetes
T1D doesn’t develop overnight. Evidence shows that beta cell destruction begins as early as 4-6 years before clinical symptoms appear.
T1D progresses in three stages, differentiated by blood glucose levels:
PRESYMPTOMATIC
Stage 1 (normoglycemia)
The autoimmune attack on insulin-producing beta cells has begun, but blood sugar remains normal, and no symptoms are present.
Stage 2 (dysglycemia)
More beta cells are lost, and blood sugar levels begin to rise, yet symptoms are still absent.
SYMPTOMATIC
Stage 3 (normoglycemia)
The disease reaches its clinical diagnosis stage,
often presenting as sudden, severe illness due to dangerously high blood sugar levels.
Once a patient enters Stage 1 or 2, the risk of progressing to Stage 3 is nearly 100%.
The Consequences of a Late Diagnosis
Currently, up to 62% of individuals with new-onset T1D are diagnosed in diabetic ketoacidosis (DKA), a condition that occurs when the body doesn’t have enough insulin to allow blood sugar into cells for energy use. Instead, the liver breaks down fat for fuel, which produces acids called ketones.
DKA can lead to severe complications, including:
- Changes in brain and growth development, particularly in children and adolescents
- Negative impact on attention span, cognitive function and memory
- Greater difficulty managing blood sugar levels
- Increased risk of future DKA occurrences
Up to 62% of individuals with new-onset T1D are diagnosed in diabetic ketoacidosis (DKA)
Screening Can Lead to Better Patient Outcomes
Autoantibody screening can reduce the incidence of DKA at diagnosis by 50% and provide families with the knowledge and tools they need to manage the disease proactively.
Early detection also plays a critical role in preserving beta cell function. Even low levels of remaining beta cells can:
- Improve blood sugar control
- Reduce the risk of severe hypoglycemia
- Lower the risk of short- and long-term complications
Screen to Be Sure
A significant challenge confronting patients is the misclassification of T1D as type 2 diabetes. Alarmingly, 40% of adults with T1D are initially diagnosed with type 2 diabetes. In pediatric cases, DKA frequently serves as the initial indicator of misclassification. Moreover, a type 2 diabetes diagnosis results in the loss of a crucial opportunity for T1D early detection and intervention.
Screening can help confirm a diagnosis, so patients can receive appropriate and timely treatment.
Who to Screen
Clinical guidelines issued by the American Diabetes Association (ADA) recommend T1D-related autoantibody testing in:
- Those with a family history of type 1 diabetes, or
- A known elevated genetic risk, especially those with certain autoimmune diseases, such as autoimmune thyroid disorders and celiac disease, or
- Adults with phenotypic risk factors that overlap with those for T1D (e.g., younger age at diagnosis, unintentional weight loss, ketoacidosis, or short time to insulin treatment)
Labs to order include:
- Insulin Autoantibody (IAA)-CPT 86337
- Glutamic Acid Decarboxylase (GAD) Autoantibody-CPT 86341
- Islet Antigen 2 (IA-2) Autoantibody-CPT 86341
- Zinc Transporter 8 (ZnT8) Autoantibody-CPT 8634
Related diagnosis codes include:
- Z83.3 — Family history of diabetes
- R73.9 — Hyperglycemia, unspecified
- Z13.1 — Screening for diabetes mellitus
Disclaimer: All labs are provided for background informational purposes, but it is the responsibility of the clinician to use the appropriate codes.
Testing options include:
- Commercial labs such as Quest or LabCorp
- Ordering test kits directly from Enable BioSciences
TrialNet
- For people 2 to 45 years old who have a parent, brother/sister, or child with T1D
- For people 2 to 20 years old who have an aunt/uncle, cousin, grandparent, niece/nephew, or half-brother/sister with T1D
- Lab or at-home tests available
ASK
- For all children ages 1-17
- No family history of type 1 diabetes is required
- At-home tests available
- Also screens for Celiac Disease
Screening Central
- Request a test directly online or speak with a telehealth provider for more support.
- Request an at-home collection kit or home visit, or visit a local lab.
- Receive a phone call or tele-visit to discuss your results (you can choose to have results shared directly with your doctor as well).
- There are many additional options for where to get screened. Talk to your patient about the option that's best for them.
Screening Affordability
There are several options available for T1D autoantibody testing, and the cost of testing for the majority of patients is nominal.
- 82% commercially insured patients pay less than $20 for T1D autoantibody testing
- 56% of commercially insured patients pay $0 for T1D autoantibody testing
Post-Screening Support
If < 2 autoantibodies or 1 autoantibody is detected
- Additional screening may be needed for high-risk patients to provide the benefits of early detection, monitoring and support.
If ≥ 2 autoantibodies are detected
- Perform a confirmatory test within 2 to 6 weeks as standard practice.
- Gain commitment to participate in regular screening to monitor progression.
- Consider establishment of care with an endocrinology care team to review advancements in treatment and management plan.
- Educate patients and families about research trials.
- Discuss signs and symptoms of hyperglycemia and DKA and encourage families to be vigilant.
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