T1D-Associated Antibody (Ab) Screening

SCREENING

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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.

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POSITIVE for ≥1 Ab

CONFIRM with Ab testing
at reference lab*

 

Obtain Random Blood Glucose (RBG) and HbA1c

CONFIRMATION

CONFIRMATION

NEGATIVE

CONFIRMATION

POSITIVE

for 1 Ab

CONFIRMATION

POSITIVE

for ≥ 2 Ab

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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

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 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)

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 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

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*  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, 7-13. 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