CONFIRMATION
POSITIVE for ≥ 2 Ab
Patient may have early-stage T1D
Evaluate for E10.A0:
Type 1 diabetes mellitus, presymptomatic, unspecified
Obtain Random Blood Glucose (RBG) and HbA1c
Follow-up to monitor for medical safety and progression to T1D
Normal RBG <140 mg/dL
and HbA1c ≤ 5.6%
Patient may have Stage 1 T1D
Evaluate for
E10.A1:Type 1 diabetes mellitus, presymptomatic, Stage 1
RBG 140-199 mg/dL
OR HbA1c 5.7-6.4%
Patient may have Stage 2 T1D
(consider Teplizumab if ≥ 8 yrs)
Evaluate for
E10.A2: Type 1 diabetes mellitus, presymptomatic, Stage 2
Age > 18y
Lower Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on Self-Monitored Blood
Glucose testing: Test 2 hours after
largest meal of day once monthly
• In 12 months: RBG, HbA1c, OGTT
and CGM
b
Age 5–18y
Medium Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on Self-Monitored Blood
Glucose testing: Test 2 hours after
largest meal of day once weekly
• In 6 months: RBG, HbA1c, OGTT
and CGM
b
Age < 5y
Higher Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on Self-Monitored Blood
Glucose testing:
–Test 2 hours after largest meal of
day for 5 days and send in
numbers.
–After initial assessment, test 2 hours
after largest meal of day once
weekly.
• In 3 months: RBG, HbA1c and CGM
• In 6 months: OGTT
• In patients ≥18y, follow-up every
6-months may be efficient.
b
RBG ≥ 200 mg/dL
OR HbA1c ≥ 6.5
Patient may have Stage 3 T1D
(needs insulin)
Evaluate for
E10.65: Type 1 diabetes mellitus
with hyperglycemia
• Evaluate for symptoms
of hyperglycemia and
ketosis
• Verbal consult with and
urgent referral to pediatric /
adult diabetologist
a
Ask the Experts can provide confirmation testing. Please contact us for additional information.
a 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.
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b Patient/family should be given educational support by experienced provider on normal CGM
excursions, normal hypoglycemia ranges, and signficance of prolonged glucose peaks.
All CGM wear should include support for issues with adhesion and skin irritation as needed.