CONFIRMATION
POSITIVE
for ≥ 2 Ab
Serum Confirmation*
* Reference lab: CLIA-approved laboratory,
ideally IASP participant, which is able to
measure all 4 Ab: GAD65A, IA-2A, Insulin,
ZnT8A.
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%
RBG 140-199 mg/dL
OR HbA1c 5.7-6.4%
Age > 18y
Lower Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on HGT 1**
• In 12 months: RBG, HbA1c
• If possible OGTT and CGM****
Age 5–18y
Age < 5y
Medium Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on HGT 2**
• In 6 months: RBG, HbA1c
• If possible OGTT and CGM****
Higher Intensity Follow-up
• Assess/Educate for symptoms
• Instruct on HGT 3**
• In 3 months: RBG, HbA1c
• If possible OGTT q6 month and
q3 month CGM****
• May be eligible for Tzield treatment
if ≥ 8 years old
RBG ≥ 200 mg/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.
​
**HGT (Home Glucose Testing) Protocol:
HGT1 (Level 1): Test 2 hours after largest meal of day once monthly
HGT2 (Level 2): Test 2 hours after largest meal of day once weekly
HGT3 (Level 3): 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.
***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.
​
****CGM should be worn blinded unless patient/family is 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.