Taking Charge Early: Navigating Treatment Options to Delay T1D Progression - Episode 5
Antibody Screening for T1D
Panelists discuss how antibody screening for type 1 diabetes can identify at-risk individuals early, enabling proactive monitoring and intervention to delay or prevent disease onset.
Morales: How do we typically screen primary populations for type 1 diabetes risk factors during routine appointments? Is it:
- Autoantibody testing?
- An oral glucose tolerance test?
- Clinical assessment of symptoms and risk factors?
- A combination of the above?
- Other methods?
Most people focus on autoantibody testing, which remains the gold standard. Dr. Choudhary, can you walk us through the current recommendations for screening?
Abha Choudhary, MD: Absolutely. The risk of developing type 1 diabetes in the general population is approximately 1 in 300. For first-degree relatives, it increases significantly to 1 in 20—a 15-fold higher risk.
The ADA and ISPAD guidelines recommend screening first-degree relatives and individuals with other autoimmune conditions, such as Hashimoto's thyroiditis and celiac disease, which are associated with a 2-3 times higher risk compared to the general population. While specific HLA genotypes are also risk markers, these are typically evaluated in research settings rather than routine practice. Key takeaway: Focus screening on first-degree relatives and individuals with autoimmune diseases like Hashimoto's and celiac.
As for when to begin screening, there’s no definitive guideline. Some experts suggest starting at birth, others at age two. The TrialNet study recommends starting at 2.5 years of age, and we'll discuss more about available screening options shortly.
Morales: That’s insightful. I think other autoimmune conditions, such as vitiligo or pernicious anemia, might also warrant consideration. What are your thoughts?
Choudhary: I think While these conditions carry some risk, the association isn’t as strong as with Hashimoto's and celiac disease. However, their presence could still justify additional screening.
Morales: Let’s explore another question: How familiar are you with the concept of antibody levels as biomarkers for disease progression and treatment response in type 1 diabetes? Options:
- Very familiar.
- Somewhat familiar.
- Not at all familiar.
Dr. Choudhary, are quantitative antibody levels now commonly measured?
Choudhary: Yes, quantitative levels are increasingly used and often repeated to monitor progression. We’ll discuss their role shortly.
Morales: I'm happy to see that two-thirds of our audience is actually very familiar with this concept of antibody level. Natalie, would you be kind enough to chime in and walk us through these types of antibody screenings for type ones?
Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES: Certainly. Several screening options are available. In our practice, we use Epic to consolidate a “Type 1 Screen” order set for autoantibodies, which can be sent to commercial labs like Quest or LabCorp.
Two major research studies also offer free screening:
- TrialNet:
- Screens first-degree relatives under age 45.
- Uses a finger stick or blood draw to test two common antibodies initially. If positive, additional antibodies are tested using stored samples.
- ASK (Autoimmune Screening for Kids):
- Open to children and adults.
- Screens for type 1 diabetes and celiac disease using a finger stick or blood draw. This program is not limited to first-degree relatives and allows for general population screening.
For self-pay options, antibody testing kits range from $100 to $150, covering key markers like GAD, IA-2A, and IAA.
Choudhary: If two or more autoantibodies are detected, the individual has a near-100% lifetime risk of developing type 1 diabetes, even without symptoms. At that point, we fast-track them to endocrinology for close monitoring.
Morales: What’s the process in endocrinology after detecting multiple antibodies?
Bellini: We initiate continuous glucose monitoring (CGM) to detect glucose spikes and assess glycemic trends. Depending on the findings, we might perform a glucose tolerance test and start patient education on carbohydrate management and type 1 diabetes progression.
Identifying patients early—whether they’re at stage 1, 2, or early stage 3—allows us to intervene before overt symptoms occur. For individuals with only one antibody, further screening is recommended to monitor risk.
Morales: That’s a comprehensive approach. Early detection and intervention make a significant difference in managing type 1 diabetes progression.
