NEGATIVE for Ab
Age < 15 years
• Currently low risk
• Consider repeat Ab screen
at recommended intervals**
Age ≥ 15 years
• Low risk
• No repeat screen unless
symptoms present
**Recommended screening "windows"
ages 1-3, 4-6, 7-13. If family history of
T1D or medical history of autoimmune
disease, consider yearly screen.
POSITIVE for ≥1 Ab
CONFIRM with Ab testing
at reference lab*
Obtain Random Blood Glucose (RBG) and HbA1c
CONFIRMATION
CONFIRMATION
NEGATIVE
Normal RBG <140 mg/dL
and HbA1c ≤ 5.6%
RBG 140-199 mg/dL
OR HbA1c 5.7-6.4%
RBG ≥ 200 mg/dL
OR HbA1c ≥ 6.5
* Reference lab: CLIA-approved laboratory, ideally IASP
participant, which is able to measure all 4 Ab: GAD65A,
IA-2A, Insulin, ZnT8A.
FOLLOW-UP
Initial screen positive for 1 Ab and age < 15 years
• Repeat Ab at reference lab*
at recommended intervals**
Initial screen positive for 1 Ab and age ≥ 15 years
• Low risk
• No repeat screen unless
symptoms present
​
Initial screen positive for ≥ 2 Ab
• Educate for symptoms of
hyperglycemia
• Repeat Ab at reference lab*
in 1 year
RBG <140mg/dL OR HbA1c ≤ 5.6%
• Assess patient for T2D risk
factors (BMI, family history
of T2D, ethnicity)
​
• Assess/Educate for
symptoms of hyperglycemia
​
• Age <18 years: Refer to
paediatric diabetologist for
further evaluation
(T1D vs T2D vs MODY)
​
• Age ≥18 years: Consider
referral to endocrinologist
for further evaluation
(T1D vs T2D vs MODY)
RBG 140-199mg/dL OR HbA1c 5.7-6.4%
RBG ≥ 200mg/dL OR HbA1c ≥6.5
• Evaluate for symptoms
of hyperglycemia and
ketosis***
• Verbal consult with
and urgent referral to
pediatric/adult diabetologist
* Reference lab: CLIA-approved laboratory, ideally IASP participant, which is able to measure
all 4 Ab: GAD65A, IA-2A, Insulin, ZnT8A.
**Recommended screening "windows" ages 1-3, 4-6, 9-11. If family history of T1D or medical
history of autoimmune disease, consider yearly screen.
***Ketosis symptoms: vomiting, nausea, abdominal pain, Kussmaul breathing, altered mental
status. If concern for ketosis, check urine or blood ketones if able, if positive or unable to test
refer for urgent evaluation at ED.
Ab: Antibody
BMI: body mass index
MODY: maturity onset diabetes of the young
RBG: random blood glucose
T1D: type 1 diabetes
T2D: type 2 diabetes