What Health Care Professionals Should Know About Early Type 1 Diabetes Screening

As American Diabetes Month begins, Shara Bialo, MD, senior medical director at Sanofi and pediatric endocrinologist living with T1D, highlights the importance of early detection for type 1 diabetes (T1D). In this interview with Pharmacy Times®, Bialo discusses how autoantibody screening can identify risk long before symptoms develop. She explains how this proactive approach can help health care professionals recognize early stages of the disease and improve patient outcomes.

Pharmacy Times: Can you introduce yourself?

Shara Bialo, MD: Thanks for having me. My name is Shara Bialo. I'm one of the senior medical directors of T1D Immunology at Sanofi. I'm also a board-certified pediatric endocrinologist, and I also live with type 1 diabetes. It's been 32 years now, so overall, I’m quite passionate about this, and I'm excited to help raise awareness around the importance of screening.

Pharmacy Times: Why is now—leading into American Diabetes Month—a particularly important time for health care professionals to discuss type 1 diabetes screening with their patients?

Bialo: You mentioned that we are upon American Diabetes Month, and that also falls at the end of the year, which can be a really busy time for endocrinology offices. It provides this crucial opportunity to talk about risk factors and early signs of health conditions, especially type 1 diabetes, which is unfortunately often overlooked.

Pharmacy Times: For HCPs unfamiliar with autoantibody screening, can you explain how it differs from glucose or genetic testing in identifying early-stage type 1 diabetes risk?

Bialo: It's a great question because I think this area creates a lot of confusion for people. Oftentimes, we think of diabetes screening, and people reflexively think of a measurement of glucose, and that's part of it, but it's not the whole picture. Autoantibody screening is able to detect immune markers. There are five available immune markers to test in blood tests that can show this active autoimmune process months to years before the blood glucose becomes abnormal.

When we find someone with persistent autoantibodies present in their blood—two or more—they pretty much have up to a 100% lifetime risk of developing clinical type 1 diabetes. A lot of people don't realize that there are actually 3 stages of type 1 diabetes. The first 2 are completely asymptomatic and are only defined by the presence of autoantibodies.

Stage one is normal blood sugar. Stage 2 is dysglycemia, or mildly abnormal blood sugar. Stage 3 is type 1 diabetes as we think of it, which is very high blood glucose, symptoms, and needing insulin at that point. We have the ability to capture that earlier with autoantibody testing.

GAD65, IA-2, zinc transporter 8, and insulin autoantibodies are the ones recommended by the American Diabetes Association. There’s a fifth autoantibody called ICA, which is available but a little less reliable, and so that didn’t make the cut for American Diabetes Association guidelines.

These measures are different from genetic testing. Genetic testing can tell us inherited risk, but it won’t actually tell us if that autoimmune process has started. Glucose testing gives us an idea of the presence or absence of metabolic failure right after the beta cells have already started to become destroyed and ineffective. At that point, it becomes later than we could have caught it had we screened for autoantibodies, which can tell us about those asymptomatic stages.