Screening for autoimmune type 1 diabetes (T1D)

Autoimmune type 1 diabetes (T1D) is a lifelong condition with a progressive nature, ¹ which is often diagnosed only after ​​symptoms appear. ² Many people, especially children under 18 years old, find out about their condition only after a medical emergency. ^2–4

Nowadays, screening tests exist that allow us to catch autoimmune type 1 diabetes early, even before symptoms appear, providing the opportunity to reduce the likelihood of starting the journey with a medical emergency and prepare for life with the condition.^2,4-5 This proactive approach empowers people and gives them time to get informed on what autoimmune type 1 diabetes means for them.

Autoimmune type 1 diabetes develops over time when the body’s immune system mistakenly attacks the insulin-producing cells of the pancreas (beta cells).¹ A type of molecule produced by the immune system, called autoantibodies, is involved in this attack; autoantibodies appear months or years before the symptoms of the disease.^5,6

Learn more about ​how autoimmune type 1 diabetes works in the body.

Screening for autoimmune type 1 diabetes can be done with a blood test, usually from a vein in the arm or from a fingertip, that identifies these autoantibodies.^2,6,7 This is different from a blood glucose level test..

When a person has one type 1 diabetes autoantibody in the blood, it means there is a higher risk of developing autoimmune type 1 diabetes in the future.⁸ If two or more different type 1 diabetes autoantibodies are found in the blood, and the result is confirmed, then autoimmune type 1 diabetes has been detected.⁸

Autoimmune type 1 diabetes screening will check the presence of four different type 1 diabetes autoantibodies in the blood.6,9 These autoantibodies can be found in the blood in different combinations.^6,8

For a long time, autoimmune type 1 diabetes has been considered a childhood condition.^10,11 Now it is known that anyone at any age can get autoimmune type 1 diabetes, although people younger than 35 years are more likely to develop this condition.^9,10

Many factors may increase the likelihood of getting autoimmune type 1 diabetes, for example:

• Having a relative with autoimmune type 1 diabetes
• Having a personal or family history of other autoimmune conditions, such as celiac or thyroid disease. ^9,15

People with a parent or a sibling with autoimmune type 1 diabetes are recommended to get an autoantibody screening for type 1 diabetes, since they have an up to 15 times higher chance (15-fold) of developing this condition than others.^2,8,13

However, most people with autoimmune type 1 diabetes do not have any family history; this means that anyone can develop the condition, and it is more often detected in people who have low body mass index and are younger than 35.^9,13

Type 1 diabetes autoantibodies usually appear between 9 months and 2 years of age.⁹ Screening for autoimmune type 1 diabetes should ideally be done early in life, initially at 2 years of age and then at 6 years of age, to improve the chance of early detection.¹⁴

Sometimes, prediabetes (a condition with blood glucose levels slightly higher than usual) and type 2 diabetes can look similar to autoimmune type 1 diabetes, even though they’re not autoimmune conditions. Screening for autoantibodies can therefore be helpful to distinguish autoimmune type 1 diabetes from type 2.^8,9

Learn more about the ​misdiagnosis of autoimmune type 1 diabetes.

Different autoimmune type 1 diabetes screening programs can be available in different areas.^2,9 Depending on where you live, your or your child’s doctor can order labs to detect type 1 diabetes autoantibodies, and your insurance may cover this. Your child’s doctor will recommend the best autoimmune T1D screening option for you among those available.

If type 1 diabetes autoantibodies are found in the first screening test, the test should be repeated 3 months later to confirm the result.⁸ If type 1 diabetes autoantibodies are not found in the second test, it is important that you monitor the appearance of potential autoimmune type 1 diabetes symptoms.^8,12

The screening test can give different results, each one suggesting a different course of action:

• If no autoantibodies are detected, autoimmune type 1 diabetes has not been detected. Repeat screening may be recommended for individuals at higher risk of developing the condition, such as those with other autoimmune conditions or a close family member (parent or sibling) with autoimmune type 1 diabetes. ¹⁵
• If one autoantibody is detected, it means there is a higher risk of developing autoimmune type 1 diabetes. Monitoring and additional screening may be recommended to see if there are any changes.⁸
• If two or more autoantibodies for type 1 diabetes are detected and the result is confirmed, then autoimmune type 1 diabetes has been detected. Further testing of blood sugar levels may be recommended to understand how the condition is progressing and at what stage you are.¹⁶

A person with Stage 1 or Stage 2 autoimmune type 1 diabetes does not show any symptoms but type 1 diabetes autoantibodies are already detectable in their blood. During Stage 3, the signs and symptoms of autoimmune type 1 diabetes are already present.^2,9

Anyone can get an autoantibody screening for type 1 diabetes. The early detection of autoimmune type 1 diabetes through screening has many benefits:

• Reduces the chance of a medical emergency
• Allows for tracking autoimmune type 1 diabetes proactively through glucose monitoring
• Provides more time to prepare for living with autoimmune type 1 diabetes.^2,5,14,17

Early diagnosis also provides the opportunity for education and support to people with autoimmune type 1 diabetes and their families, helping them feel as comfortable and informed as possible throughout the progression of the condition.² On the other hand, screening can provide relief and reassurance if type 1 diabetes autoantibodies are not detected.²

Screening Doctor Discussion Guideopen_in_new

T1D, type 1 diabetes.