Examining the Burden of T1D

The following transcript has been edited for clarity and length.

Javier Morales, MD: Good evening, and thank you for joining us for Patient Care Frontline Insights. Tonight’s presentation is titled Taking Charge Early: Navigating Treatment Options to Delay Type 1 Diabetes Progression. I’m Javier Morales, associate clinical professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and I’ll be moderating this session.

I’m thrilled to share this platform with three esteemed clinicians in diabetes care. Joining me are Dr. Natalie Bellini, associate professor of medicine at Case Western Reserve University School of Medicine; Dr. Abha Choudhary, a pediatric endocrinologist from Dallas, Texas; and Dr. Aubrey Molgaard.

Tonight, we’ll cover a range of topics. We’ll start by aligning with the objectives of National Diabetes Month, emphasizing prevention and early intervention for newly diagnosed type 1 diabetes. We’ll discuss the role of early screening—focusing on processes, tools, and eligibility criteria—to identify at-risk individuals and delay disease progression.

Additionally, we’ll explore the importance of staging type 1 diabetes to help healthcare professionals understand how early interventions, including teplizumab, can delay further progression. We’ll also navigate the practicalities of teplizumab treatment, including implementation strategies, managing the 14-day infusion process, and building effective referral networks. Finally, we’ll focus on optimizing patient outcomes by equipping healthcare providers with strategies to reduce complications, such as diabetic ketoacidosis (DKA).

Before we begin, I have a question for the audience: Which populations are at increased risk for developing type 1 diabetes?
A. Children and adolescents
B. Adults over age 30
C. Individuals with a family history of type 1 diabetes
D. People with autoimmune conditions
E. None of the above

Please cast your votes.

No surprise—most responses suggest people with autoimmune conditions are at higher risk. Other groups, including children, adults over 30, and those with a family history of type 1 diabetes, were also recognized. We’ll delve into the correct answer during the presentation.

At this point, I’ll turn it over to my colleague, Dr. Aubrey Molgaard. Aubrey, can you walk us through some of the data?

Aubrey Molgaard, DNP, ARNP, FNP-BC, CDCES: Thank you, Javier. Let’s talk about the burden of type 1 diabetes. Each year, approximately 64,000 Americans are diagnosed with this condition. It affects both children and adults: 41% of diagnoses occur in individuals under 20 years old, while 59% occur in those over 20.

Having a family history of type 1 diabetes significantly increases risk—a first-degree relative has a 15-fold greater likelihood of developing the disease compared to the general population.

November 14th marked Diabetes Awareness Day, and the theme for 2024-2026 is Diabetes and Well-being. This underscores the emotional, social, and economic challenges faced by people with diabetes. For example:

• 36% report diabetes distress, a common issue due to the daily management required.
• 63% fear diabetes-related complications, impacting their overall well-being.
• 28% find it difficult to remain positive about their condition.

Managing diabetes is a constant challenge, affecting blood sugar control, treatment adherence, and daily life. Collaborative care can enhance patient well-being while effectively managing the disease.

Morales: Aubrey, it’s striking how diabetes distress affects not just diagnosis and treatment but also adherence. What challenges do you face in ensuring better outcomes?

Molgaard: The main challenges are ensuring accurate diagnoses, engaging patients and their support systems, and providing clear education about the disease. Addressing clinical inertia is crucial—we must initiate appropriate therapies promptly to improve glucose control and reduce complications like microvascular and macrovascular disease.

Abha Choudhary, MD: As a pediatric endocrinologist, I see many teenagers newly diagnosed with diabetes. The burden on them is immense—they must monitor blood sugar, watch their diet, and balance it all with typical life challenges.

Molgaard: Absolutely. As someone who treats adults and has a child with type 1 diabetes, I see how this burden affects people across the lifespan. It impacts not only individuals but also their families and support systems. Anything we can do to reduce that burden is vital.

Morales: Natalie, can you walk us through the American Diabetes Association’s (ADA) recommendations for screening and early intervention?

Bellini: Of course. The ADA has emphasized the importance of screening for type 1 diabetes to reduce the risk of DKA at diagnosis. Currently, 40–60% of new type 1 diabetes cases in the U.S. are diagnosed during DKA, a potentially life-threatening condition. Early screening can reduce this rate to as low as 2–6%.

Screening involves identifying individuals at risk through antibody testing, particularly in populations with a family history or atypical presentations of diabetes. Importantly, type 1 diabetes can occur in individuals with overweight or obesity—a stark contrast to the stereotypical image of a thin adolescent with diabetes.

The ADA’s guidelines are supported by several organizations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the National Association of Pediatric Nurse Practitioners (NAPNAP). These endorsements highlight the critical need for early detection and intervention.