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, providing the opportunity to get ahead of ​​complications and prepare for life with the condition. ^4-5

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 antibodies. ^2,6,7 This is different from a blood glucose level test.

When a person has two or more type 1 diabetes autoantibodies in the blood, they are likely to develop autoimmune type 1 diabetes.^1,8

For a long time, autoimmune type 1 diabetes has been considered a childhood condition. ^11,12 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. ^8,11

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. ^9,13

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 a 15 times higher chance (15-fold) of developing this condition than others. ^2,10,13

However, most people with autoimmune type 1 diabetes do not have any family history; this means that everyone can develop the condition, especially if they have high blood glucose, low body mass index, and are younger than 35. ^9,14

Type 1 diabetes autoantibodies usually appear before the age of 6 years. ^13,15 Screening for autoimmune type 1 diabetes should be done early in life, ideally at 2 years of age and then at 6 years of age, to improve the chance of early detection. ^{13, 16}

Sometimes, prediabetes and type 2 diabetes can look similar to autoimmune type 1 diabetes, so getting screened is useful to confirm that someone with high blood glucose does not have autoimmune type 1 diabetes, or it may indicate that they are likely to develop it in the future. ^9,10

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, you 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. ¹⁰ If T1D autoantibodies are not found in the second test, it is important that you monitor the appearance of potential autoimmune type 1 diabetes symptoms. ^10,13

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

• If none of the autoantibodies for type 1 diabetes are found in the blood sample, your doctor may suggest having an annual screening for autoimmune type 1 diabetes. ¹³
• If 1 autoantibody is found, the person is likely to develop autoimmune type 1 diabetes in the future, and the doctor will suggest monitoring blood glucose levels; at this stage, there are no symptoms of autoimmune type 1 diabetes. ^2,10
• If 2 or more autoantibodies for type 1 diabetes are found, the person is highly likely to have presymptomatic Stage 1 or 2 autoimmune type 1 diabetes; another blood sample will be collected, and the autoantibody test will be repeated to confirm the result. ^9,10

​​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

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T1D, type 1 diabetes.