Question 1

What’s the best way to get someone screened for type 1 diabetes?

Accepted Answer

Answer: Order a validated islet autoantibody (IAb) panel covering GADA, IA‑2A, IAA, and ZnT8A. Screening can be done via standard commercial labs or research programs when clinical access is limited.

Take Action: Identify at‑risk patients during annual and problem visits; prioritize patients with a family history of T1D or autoimmunity, abnormal fasting glucose or HbA1c, or symptoms suggestive of dysglycemia; order Quest Diabetes Type 1 Autoantibody Panel (13621) or LabCorp Diabetes Autoimmune Profile (504050); include IAA (CPT 86337) and the other IAb (CPT 86341); document screening and family history (ICD‑10 Z13.1, Z83.3, Z83.49).

Key Info: Recommended ages for childhood screening are 1–3, 4–6, 9–11, and once after age 18; adults with abnormal glucose or autoimmunity also benefit from screening; single‑positive results must be confirmed from a new sample.

Tools & Resources: 
Early-Stage T1D Basics (https://askstudy001.wixsite.com/askexperts/hcp-t1d-basics)

Quest 13621
LabCorp 504050  
CPT 86341/86337  
ICD‑10 Z13.1/Z83.3/Z83.49

Question 2

How do I confirm positive antibody results?

Accepted Answer

Answer: Confirm by re‑testing all four islet autoantibodies (IAb) from a new serum sample in a CLIA/CAP‑certified reference lab; avoid relying on a single ELISA‑only assay when better platforms are available.

Take Action: Repeat within 1–3 months (ideally within 1 month); order GADA, IA‑2A, ZnT8A (CPT 86341) and IAA (CPT 86337) again; code R76.0 (raised antibody titer) as appropriate; counsel family that monitoring decisions should wait for confirmation if the patient is asymptomatic and euglycemic.

Key Info: Confirmation reduces false positives and aligns monitoring with true risk; stage and metabolic plan should be based on confirmed status and glycemia. Confirmation should never delay clinical care when there is evidence of dysglycemia or hyperglycemia.

Tools & Resources:

Question 3

If a prior antibody screen was negative, when should I re‑screen?

Accepted Answer

Answer: Re‑screen higher‑risk patients (family history, genetic risk) annually where feasible, or at the age windows 1–3, 4–6, and 9–11 years; adult data is limited, but consider screening once during adulthood

Take Action: Add reminders in the EMR; offer research/at‑home options when clinical access is limited.

Key Info: Antibody status can change over time; repeat testing captures seroconversion, reduces DKA at diagnosis and lets patients consider all treatment options.

Tools & Resources:

Question 4

What should I do if the HbA1c or glucose level is elevated or the patient is symptomatic?

Accepted Answer

Answer: If the patient has hyperglycemia or symptoms of diabetes, do not wait for islet autoantibody results to act. Immediate evaluation for type 1 diabetes is warranted. Check ketones right away if possible (urine or blood). If ketones are elevated, arrange urgent endocrinology evaluation; if ketones are moderate-to-large and/or glucose is ≥200 mg/dL with symptoms, refer directly to the emergency department for diabetic ketoacidosis (DKA) evaluation. If ketone testing is not available in your setting, refer the patient immediately to a lab, urgent care, or ED depending on symptom severity.

Take Action: Expedite endocrine referral if hyperglycemia persists or symptoms escalate.

Key Info: Early ketone testing and urgent specialist or ED referral when indicated can prevent progression to DKA. Symptoms to watch for include polyuria, polydipsia, fatigue, unexplained weight loss, nausea, vomiting, abdominal pain, and rapid breathing. Many primary care settings lack glucose meters and teaching capacity, so plan ahead for how to triage and refer promptly.

Tools & Resources: Breakthrough T1D (https://www.breakthrought1d.org/t1d-basics/symptoms/)and Beyond Type 1(https://beyondtype1.org/seethesigns/)

Question 5

How do I stage early T1D after antibodies are confirmed?

Accepted Answer

Answer: Once a patient has two or more confirmed islet autoantibodies, they meet criteria for early-stage type 1 diabetes. Per ADA guidelines, HbA1c, fasting glucose, and/or an oral glucose tolerance test (OGTT) can be used to determine the stage. The OGTT is the most sensitive test for detecting progression and the hardest for patients to manipulate. Continuous glucose monitoring (CGM) is not yet a validated diagnostic tool but can provide helpful trend data as an emerging adjunct. If full metabolic evaluation is performed, it is common for staging results to differ between tests (e.g., normoglycemia on HbA1c but dysglycemia on OGTT). In these cases, clinical judgment and/or consultation with a specialist are necessary to decide next steps. If the patient is Stage 2 or Stage 3 by any test category, referral to pediatric or adult endocrinology is indicated.

Take Action: Obtain HbA1c, fasting glucose, and/or OGTT, applying ADA diagnostic thresholds to determine stage. When possible, document early-stage type 1 diabetes using appropriate ICD-10 codes (E10.A0 – unspecified stage; E10.A1 – Stage 1; E10.A2 – Stage 2). Discuss with patients how an early-stage diagnosis could affect areas such as life insurance eligibility and provide resources to help them make informed decisions.

Key Info: Staging informs visit cadence, follow-up monitoring modality, treatment eligibility (e.g., teplizumab for Stage 2) and clinical trial eligibility.

Tools & Resources: 
https://static.wixstatic.com/media/71a2f0_5c6174c5ddf94a8aa22c7457616ddaf5~mv2.png
[Download this graphic in the PDF-file below]

Question 6

What’s the monitoring plan for pediatric Stage 1 T1D?

Accepted Answer

Answer: For children with ≥2 IAb+ and normal glycemia, repeat HbA1c and either random BG or short‑term CGM at age‑appropriate intervals. OGTT can also be considered. Current recommendations suggest:
 • Children <3 years old: every 3 months
 • Children 3–9 years old: at least every 6 months
 • Children >9 years old: at least every 12 months
An increase in HbA1c of ≥10% from baseline, even if still in the normal range (e.g., from 5.0% to 5.5%), is associated with a significantly increased risk of progressing to stage 3 within a median of 1 year.

Take Action: Consider using HbA1c and/or CGM to determine changes in an individual’s baseline according to the child’s age-based follow-up monitoring schedule. If an increase of ≥10% in HbA1c is observed or if ≥10% time above 140 mg/dl on CGM is present, further metabolic evaluation, including an OGTT is warranted. Patient should be prescribed a glucometer and know how to check glucose at home 2-hours post a large meal at least once per month and when ill.

Key Info: Early detection of subtle HbA1c or CGM increases allows for timely staging changes and potential intervention. Following HbA1c is supported by longitudinal data showing that modest increases within the normal range are predictive of near-term progression.

Tools & Resources:

Question 7

What’s the monitoring plan for pediatric Stage 2 T1D?

Accepted Answer

Answer: For children with ≥2 IAb+ and dysglycemia, use HbA1c, 2‑hour glucose after OGTT, and/or CGM every 3 months.

Take Action: Complete metabolic monitoring with HbA1c, CGM, and/or OGTT every 3 months. Schedule visits every 3 to 6 months.

Key Info: Stage 2 monitoring targets timely identification of Stage 3 to avoid DKA and to evaluate delay‑of‑onset options (e.g. teplizumab, clinical prevention trials). Patients should have access to a glucometer and know to check glucose at home 2-hours post a large meal at least once per month and when ill. Patients should have over-the-counter urine ketone test strips to help healthcare teams triage if glucoses are elevated.

Tools & Resources:

Question 8

How should I monitor adults with Stage 1 T1D?

Accepted Answer

Answer: Adults with ≥2 IAb+ and normoglycemia should receive HbA1c yearly and be provided a glucometer to test glucose with symptoms/illness; adjust frequency based on individual risk and any glycemic drift.

Take Action: Repeat HbA1c every 12 months; if A1c increases by ≥10% or glucose checks drift upward, stage with OGTT and consider more frequent follow‑up.

Key Info: Adult progression can be slower or faster depending on context; individualized cadence is appropriate.

Tools & Resources:

Question 9

How should I monitor adults with Stage 2 T1D?

Accepted Answer

Answer: Adults with ≥2 IAb+ and dysglycemia generally benefit from HbA1c every 6 months plus intermittent CGM or structured self-monitoring of blood glucose; OGTT may be used to stage formally.

Take Action: Complete metabolic monitoring with HbA1c, CGM, and/or OGTT every 6 months. Schedule visits every 6-12 months.

Key Info: Stage 2 monitoring targets timely identification of Stage 3 to avoid DKA and to evaluate delay‑of‑onset options (e.g. teplizumab, clinical prevention trials). Patients should have access to a glucometer and know to check glucose at home 2-hours post a large meal at least once per month and when ill. Patients should have over-the-counter urine ketone test strips to help healthcare teams triage if glucoses are elevated.

Tools & Resources:

Question 10

What if my patient was multiple autoantibody positive (MAB+) at screening but single autoantibody positive (SAB+) on confirmation?

Accepted Answer

Answer: Treat prior multiple autoantibody positive as high risk: follow as if patient has multiple autoantibodies unless patient is normoglycemic x 3 years.

Take Action: Repeat A1c every 6 months and provide instructions on self-monitoring of blood glucose; repeat IAs in 6–12 months; consider OGTT if glycemia drifts or symptoms arise.

Key Info: Historical MAB+ indicates higher risk of progression to stage 3 type 1 diabetes.

Tools & Resources:

Question 11

How do I approach suspected T2D that may actually be autoimmune T1D?

Accepted Answer

Answer: Screen for islet IAb in individuals with atypical “T2D” (lean phenotype, rapid progression to insulin, other autoimmunity, or poor response to non‑insulin agents).

Take Action: Order all four IAb; if measuring c-peptide, make sure that it is a stimulated test (1 or 2 hours post a meal).

Key Info: A substantial fraction of adult‑onset T1D is initially labeled T2D; correct classification improves outcomes. Weight does not determine the type of diabetes as autoimmune T1D occurs in individuals of all weights.

Tools & Resources:

Question 12

How can I systematically find at‑risk patients in my practice?

Accepted Answer

Answer: Leverage EMR registries, health‑maintenance rules, and intake questionnaires to surface family history, autoimmune comorbidities, and abnormal glucose for proactive outreach.

Take Action: Implement best‑practice alerts for ICD-10 codes and elevated glucose; add screening prompts to well‑visit templates; run monthly panel reports to invite screening.

Key Info: Systematic identification normalizes screening and improves equity of access. Remember that T1D can present with symptoms that overlap with common complaints. Always have T1D on your differential and check a urine or blood glucose.

Frequently Asked Questions