Clinician Shares Personal Insight on the Importance of Early Type 1 Diabetes Screening

Shara Bialo, MD, senior medical director at Sanofi and pediatric endocrinologist living with T1D, continued her discussion, sharing how her experience living with type 1 diabetes and parenting 2 children shaped her perspective on early screening. She discusses the emotional and practical challenges of deciding to screen her own children, ultimately finding empowerment and reassurance through the process. Bialo also emphasizes the critical role health care professionals and pharmacists can play in promoting screening, educating families, and preventing avoidable complications through early detection.

Pharmacy Times: From your perspective as both a clinician and someone living with type 1 diabetes, why is early screening so personally meaningful to you?

Shara Bialo, MD: I know I can't really separate the personal experience from the professional experience—it's just sort of pervasive, right? Type 1 diabetes impacts every minute of every day. It doesn't matter if I'm spending those minutes outside of work with my family or in an engagement like this or in a meeting. Type 1 diabetes is always along for the ride, so it's ever-present, and it always matters.

I think screening is not something that I was always open to. Because I felt that burden of type 1 all the time—and as a parent with 2 kids—I knew how horrific my own diagnosis was for my family. You would think it would be easy to say, “I don't want that to happen to my kids, so I should screen them early.” But it's not always easy to be scientific and factual when a chronic disease like type 1 can also be so emotional.

I was afraid of the results. I was afraid that I might have some part in increasing my own children's risk of developing type 1. It took me a while to come around, and it took trusting conversations with their medical team, with the rest of my family, and with my husband to feel confident taking that step forward. But I'm so glad I did.

I think I put it off because, like you and like the audience here, we're informed—we're educated, health care–involved people. I thought, “Oh, I'll notice the signs. My kids won't end up in DKA [diabetic ketoacidosis].” But if you look at the literature, that's actually not true. A lot of people end up in DKA despite a family history of type 1 and prior knowledge.

Ultimately, I was fueled by the idea that if screening was positive, it would be a huge family change—but it would be on our own time and within our control as much as possible. It would allow us to leverage that advance notice in ways that could benefit us far more than if we were caught off guard in an emergency situation.

What I hadn’t allowed myself to appreciate was that when my kids screened negative—thank goodness—I would feel such relief. I continue to get them rescreened, but before that, I hadn’t really envisioned the possibility of a negative result. When it happened, I found such comfort in knowing I had taken action and gained reassurance that they weren’t in any immediate danger. That meant so much to me and my family.

Every year around American Diabetes Month, I reflect on this journey. Hopefully, my personal experience can inspire someone else to take the leap and feel just as empowered as I do.

Pharmacy Times: What practical steps can health care providers (HCPs) take during year-end or annual visits to incorporate screening into routine patient care?

Bialo: We just mentioned how pharmacists actually have more touchpoints than many HCPs. These end-of-year appointments and checkups are often among the few opportunities families have with their doctors.

HCPs can make the most of this time. Although time is limited, it sometimes only takes a minute of advocacy to educate a family, advocate for decisions that impact their health, and empower them to make informed choices.

It can be something as simple as asking about personal or family history of autoimmune disease—a single question in the intake. If risk is identified, an autoantibody panel can be ordered. There are multiple ways to order screening, including group testing and commercial labs like Labcorp and Quest.

There are also large-scale national screening studies like TrialNet and the ASK study out of the Barbara Davis Center, which are research-based and therefore free. These programs can send kits to homes for autoantibody screening. Companies like Enable Biosciences and Remedy also offer point-of-care testing kits that can be used in clinic settings or sometimes even at home.

HCPs can conduct this testing themselves or refer patients to someone comfortable with it. Using that annual visit to provide brief education, a handout, or a referral link—like ScreenForType1.com—is a fantastic way to share resources and tips on how to talk about screening.

Finally, documentation matters. Note that the conversation happened, so it can be revisited during future visits. It’s rarely a one-and-done topic. As with most things in life, repetition is key.

Pharmacy Times: Is there anything you would like to add?

Bialo: I really appreciate the advocacy and attention through this platform and your time. American Diabetes Month is a perfect opportunity to normalize conversations about type 1 diabetes risk and screening.

It’s not an all-or-nothing endeavor—small changes in routine practice, like a screening question, pharmacist referral, or autoantibody order for the right patients, can all move us closer to preventing avoidable complications and giving families time to prepare.

It will take grassroots efforts like this until a more formal infrastructure is in place for routine, widespread implementation. But we have to start somewhere, and I believe we’re morally obligated to take action—knowing that the outcome can benefit patients far more than the alternative of doing nothing.