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CONFIRMATION

POSITIVE

for ≥ 2 Ab

Serum Confirmation*

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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.

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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****

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.

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