<h2>Meet Aïcha&nbsp;</h2>
Aïcha, a 53-year-old mother of three teenagers, was diagnosed with autoimmune T1D in her late 40s. The condition was not unfamiliar to her, as her sister had been diagnosed with it many years earlier at age 12. Aïcha's journey with autoimmune T1D continued with her twin boys also having the condition, while her daughter, thankfully, screened negative, offering some much-needed relief.&nbsp;

It’s important to recognise that people, like Aïcha, who have a first-degree relative with autoimmune T1D, have up to 15x higher risk of developing the condition compared to the general population.4 Proactively screening for autoimmune T1D in those with a known family history of the condition allows you to detect it before symptoms arise.*5–7&nbsp;

<h2>Meet Korey&nbsp;</h2>
A licensed clinical psychologist and part of the diabetes care team at Stanford University, Korey lives with autoimmune T1D, alongside coeliac disease and an autoimmune thyroid condition. His diagnoses have resulted in dietary restrictions that can make social gatherings tricky. Familiar with the lifestyle adaptations needed for life with autoimmune T1D, Korey is a keen advocate for screening and has already had his eldest tested for the condition.

People like Korey demonstrate the high degree of co-occurrence between autoimmune T1D and other autoimmune conditions. Of those living with autoimmune T1D, up to 9% also have coeliac disease, and up to 30% also have autoimmune thyroid conditions.8,9 Understanding the genetic link between certain autoimmune conditions can help you identify which patients to screen as a priority.&nbsp;

<h2>Meet Alizée&nbsp;</h2>
Meet Alizée, a 30-year-old woman living with autoimmune T1D. With no family history of the condition and no other risk factors, her diagnosis at 19 years old came unexpectedly.&nbsp;

Although people with a family history of autoimmune T1D are at a significantly higher risk of developing the condition, the majority (~90%) of new diagnoses occur in people like Alizée, who have no family history of the condition.†4,10 So, while some risk factors may position some individuals as higher priority screening candidates, it’s important to understand that everyone has the opportunity to get ahead of autoimmune T1D through universal screening. &nbsp;
<h2>Meet Veerle&nbsp;</h2>
Veerle is 34 years old and was diagnosed with autoimmune T1D after an initial misdiagnosis of type 2 diabetes. She was the first in her family to be diagnosed with autoimmune T1D but has distant cousins who have since been diagnosed too.&nbsp;

In a retrospective US study, ~40% of adults with autoimmune T1D were initially misdiagnosed with another condition, with 77% of these cases being misdiagnosed as type 2 diabetes.‡11 Misdiagnosis can delay proper insulin replacement therapy, resulting in prolonged hyperglycaemia and increasing the risk of diabetic ketoacidosis (DKA).11 This underpins the importance of considering autoimmune T1D in certain individuals suspected as presenting with type 2 diabetes.&nbsp;
Healthcare professionals like you, who understand the importance of proactive screening, can transform the lives of those with autoimmune T1D. By detecting the condition before symptoms appear, you can help protect more people from the potential dangers of a later diagnosis.5–7,12,13&nbsp;

With timely diagnosis, it is estimated that an additional ~670,000 lives&nbsp;could be saved by 2040.14,15&nbsp;

While people from all backgrounds can develop autoimmune T1D, regardless of age or family history, 10,16 being vigilant about the risk factors can help you identify which patients should be prioritised for screening.1,8,9&nbsp;
<h3>GET 1 STEP AHEAD OF AUTOIMMUNE T1D THROUGH SCREENING. &nbsp;</h3>

Abbreviations&nbsp;
DKA, diabetic ketoacidosis; T1D, type 1 diabetes&nbsp;
Footnotes&nbsp;
*The T1D index is a data simulation tool designed to measure and map the human and public health impact of autoimmune T1D.14,15&nbsp;
†In a population-based observational study of 57,371 young individuals with autoimmune T1D across Germany, Austria, Switzerland and Luxembourg (using data from the Diabetes Prospective Follow-up Registry between 1995 and 2018), 53,606 (93.4%) had no family history of autoimmune T1D.10&nbsp;
‡In a retrospective online survey of patients with autoimmune T1D and caregivers of patients with autoimmune T1D in the US, a diagnosis of autoimmune T1D was missed in 38.6% of those diagnosed at ≥18 years of age. Of those patients, 76.8% were initially diagnosed with type 2 diabetes.11&nbsp;
References&nbsp;
<ol>
 <li>DiMeglio LA, Evans-Molina C and Oram RA. Lancet. 2018;391(10138):2449-2462.&nbsp;</li>
 <li>Insel RA, Dunne JL, Atkinson MA, et al. Diabetes Care. 2015;38(10):1964-1974.&nbsp;&nbsp;</li>
 <li>Ospelt E, Hardison H, Rioles N, et al. Clin Diabetes. 2024;42(1):17-26.&nbsp;</li>
 <li>Besser REJ, Bell KJ, Couper JJ, et al. Pediatr Diabetes. 2022;23(8):1175-1187.&nbsp;</li>
 <li>Narendran P. Diabetologia. 2019;62(1):24-27.&nbsp;</li>
 <li>Raab J, Haupt F, Scholz M, et al. BMJ Open. 2016;6(5):e011144.&nbsp;</li>
 <li>Sims EK, Besser REJ, Dayan C, et al. Diabetes. 2022;71(4):610-623.&nbsp;</li>
 <li>Barker JM. J Clin Endocrinol Metab. 2006;91(4):1210-1217.&nbsp;</li>
 <li>Głowińska-Olszewska B, Szabłowski M, Panas P, et al. Front Endocrinol (Lausanne). 2020;11:476.&nbsp;&nbsp;</li>
 <li>Karges B, Prinz N, Placzek K, et al. Diabetes Care. 2021;44(5):1116-1124.&nbsp;</li>
 <li>Muñoz C, Floreen A, Garey C, et al. Clin Diabetes. 2019;37(3):276-281.&nbsp;</li>
 <li>Wolfsdorf JI, Glaser N, Agus M, et al. Pediatr Diabetes. 2018;19 Suppl 27:155-177.&nbsp;</li>
 <li>Besser REJ, Ng SM, Gregory JW, et al. Arch Dis Child. 2022;107(9):790-795.&nbsp;</li>
 <li>Type 1 Diabetes Index. T1D Index Factsheet: GLOBAL. Accessed August 5, 2024. https://t1dindex.shinyapps.io/dashboard/&nbsp;</li>
 <li>Type 1 Diabetes Index. A campaign guide to launch the T1D Index. Accessed August 5, 2024. https://www.t1dindex.org/wpcontent/uploads/2022/09/Campaign-Guide.pptx-2.pdf&nbsp;</li>
 <li>Gregory GA, Robinson TIG, Linklater SE, et al. Lancet Diabetes Endocrinol. 2022;10(10):741-760.&nbsp;</li>
</ol>

The progression of autoimmune type 1 diabetes (T1D) is gradual, often detectable months or even years before symptoms arise.1–3 Through proactive screening, we can identify the condition well in advance.3 Meet our ambassadors living with autoimmune T1D and discover the risk factors to look out for when considering who to screen.

TYPE-1-DIABETES

DIABETES

Real-life stories from people living with autoimmune T1D 

*Polyautoimmunity is the occurrence of ≥2 autoimmune diseases in a single patient; †Family autoimmunity presence of ≥2 autoimmune diseases in members of a nuclear family

<h2>Could autoantibodies serve as markers for autoimmunity in T1D?</h2>
In some patients, autoimmune T1D is associated with the presence of additional autoimmune diseases, such as autoimmune thyroid disease, celiac disease, and Addison’s disease, which could lead to the production of organ-specific autoantibodies.1 
Autoantibodies such as insulin autoantibodies (IAA), glutamic acid decarboxylase-65 (GAD-65), islet cell antigen 2 (IA-2), and islet cells autoantibodies (ICA), may be present for years prior to the diagnosis of autoimmune T1D and could serve as markers of autoimmune T1D.1

<h2 style="margin-top: 8px; margin-bottom: 8px;">Do other associated autoimmune diseases frequently coexist with autoimmune T1D?</h2>
Concomitant autoimmune conditions may represent additional burden and complications in patients with autoimmune T1D.3,7 In the US, the prevalence of autoimmune diseases is higher in Caucasians and women and tends to rise with advancing age.7 &nbsp;
Please refer to the below figure to know more about the prevalence of other associated autoimmune diseases linked with autoimmune T1D.
<h3 style="margin-top: 8px; margin-bottom: 8px;">Prevalence of other associated autoimmune diseases linked with autoimmune T1D1,2</h3>

<h2>Is there a familial association between autoimmune T1D and other associated autoimmune diseases?</h2>
A familial association of T1D with other associated autoimmune diseases has been observed. Several genes linked to T1D risk also increase the chance of other associated autoimmune diseases.8 
The inheritance pattern of autoimmune diseases is complex and involves multiple factors, including the consolidated impact of genotype and environmental triggers.2
<h3 style="margin-top: 8px; margin-bottom: 8px;">Risk for autoimmune T1D</h3>
Autoimmune T1D puts first-degree relatives of patients at 1.6-times increased risk. A significant association for singleton siblings was found for autoimmune T1D (SIR = 2.14).2
Autoantibodies may develop sequentially. First-degree relatives expressing autoantibodies to IAA, GAD-65, and IA-2 had a 75% 5-year risk of diabetes vs 25% 5-year risk in relatives expressing only one of those autoantibodies.1 People diagnosed with Stage 2 autoimmune T1D have a near 100% lifetime chance of progression to Stage 3 autoimmune T1D, with 75% of them progressing within five years.9&nbsp;
<h3 style="margin-top: 8px; margin-bottom: 8px;">Risk for other associated autoimmune diseases</h3>
Family autoimmunity is characterized by presence of ≥2 autoimmune diseases in members of a nuclear family.2 Autoimmune T1D also confers an increased risk of autoimmune diseases in first-degree relatives, with 8% and &lt;6% developing autoimmune thyroid disease and celiac disease, respectively.1
In a first population-level study that assessed the familial risks for T1D and a large number of other associated autoimmune diseases using MigMed database found that:8
T1D in offspring was associated with the following diseases in parents

Individuals with a first-degree relative with T1D have approximately 15-fold increased relative risk of developing T1D1

<h2>Do common genetic risk factors overlap for the autoimmune diseases?</h2>
Shared genetic risk factors and immune system dysregulation are potentially implicated both in polyautoimmunity and family autoimmunity among individuals with autoimmune T1D.2 Human leukocyte antigen (HLA) genotypes, PTPN22 gene, and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) — all contribute to the complex interplay of genetic factors in autoimmune diseases that overlap with autoimmune T1D, as depicted in the below figure.1
<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">
 <tbody>
 <tr>
 <td style="background-color: rgb(112, 34, 221);">Genotype</td>
 <td style="background-color: rgb(112, 34, 221);">
 Disease association</td>
 <td style="background-color: rgb(112, 34, 221);">Additional information</td>
 </tr>
 <tr>
 <td>
 HLA
 DR3-DQ2 &amp; 
 DR4-DQ8</td>
 <td>
 <ul style="margin-top:4px; margin-bottom:4px">
 <li>Highest risk of autoimmune T1D</li>
 <li>DR3-DQ2 is also strongly associated with celiac disease</li>
 <li>DR3-DQ2 expression is also reported in members of family with autoimmune thyroid disease and autoimmune T1D</li>
 </ul></td>
 <td>
 <ul>
 <li>By the age of 15 years, 5% of individuals with this genotype expression develop autoimmune T1D</li>
 </ul></td>
 </tr>
 <tr>
 <td>
 MHC class I chain related gene A
 Polymorphism of MIC-A (especially alleles 5 and 5.1)</td>
 <td>
 <ul>
 <li>Strongly associated with T1D and celiac disease (alleles 4 and 5.1)</li>
 </ul></td>
 <td>
 <ul>
 <li>Homozygous MIC-A 5.1 allele expression along with positivity for 21-OH enzyme is known to predispose individuals with autoimmune T1D to Addison’s disease</li>
 </ul></td>
 </tr>
 <tr>
 <td>
 Polymorphism of PTPN22 gene, encoding LYP</td>
 <td>
 <ul>
 <li>Associated with autoimmune T1D, Grave’s disease, rheumatoid arthritis, systemic lupus erythematosus and Addison’s disease</li>
 </ul></td>
 <td>NA</td>
 </tr>
 <tr>
 <td>
 CTLA-4</td>
 <td>
 <ul style="margin-top:4px; margin-bottom:4px">
 <li style="margin-top:4px; margin-bottom:4px">Linked to autoimmune thyroid disease and Addison’s disease</li>
 </ul></td>
 <td>
 <ul>
 <li>More strongly linked to patients affected with Addison’s disease in association with autoimmune T1D and autoimmune thyroid disease vs Addison’s disease alone</li>
 </ul></td>
 </tr>
 </tbody>
</table>
21-OH; 21-hydroxylase; AITD autoimmune thyroid disease; CTLA-4, cytotoxic T lymphocyte-associated antigen-4; HLA, human leukocyte antigen; LYP, lymphoid tyrosine phosphatase; MIC-A, MHC-I related gene; T1D, type 1 diabetes.

<h2>ADA guideline recommendations for screening of autoimmune diseases in autoimmune T1D</h2>
Individuals with an existing autoimmune disease are more prone to develop other associated autoimmune diseases.4-6,10 
The <a href="https://diabetesjournals.org/care/article/47/Supplement_1/S52/153956/4-Comprehensive-Medical-Evaluation-and-Assessment" style="color:#0066ff; text-decoration:underline">2024 ADA guidelines on Comprehensive Medical Evaluation and Assessment of Comorbidities</a> recommend screening for autoimmune thyroid disease soon after a T1D diagnosis and periodically, thereafter. Additionally, screening for celiac disease is recommended in the presence of gastrointestinal symptoms, signs, laboratory manifestations, or suspicion of celiac disease.10

Screening for autoantibodies to identify individuals at risk for autoimmune T1D

Screening for autoimmune T1D should be advised in individuals with other associated autoimmune diseases, given their higher risk than general population4‑6

References
<ol style="margin-top:8px; margin-bottom:8px">
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Barker JM. Clinical review: Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab. 2006;91(4):1210–1217.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Cardenas-Roldan J, Rojas-Villarraga A, Anaya JM. How do autoimmune diseases cluster in families? A systematic review and meta-analysis. BMC Med. 2013;11:73.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Glowinska-Olszewska B, Szablowski M, Panas P, et al. Increasing co-occurrence of additional autoimmune disorders at diabetes type 1 onset among children and adolescents diagnosed in years 2010-2018-single-center study. Front Endocrinol (Lausanne). 2020;11:476.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Ferrari SM, Fallahi P, Ruffilli I, Elia G, Ragusa F, Benvenga S, Antonelli A. The association of other autoimmune diseases in patients with Graves' disease (with or without ophthalmopathy): Review of the literature and report of a large series. Autoimmun Rev. 2019 Mar;18(3):287-292. </li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Zelissen PM, Bast EJ, Croughs RJ. Associated autoimmunity in Addison's disease. J Autoimmun. 1995 Feb;8(1):121-30.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Lauret E, Rodrigo L. Celiac disease and autoimmune-associated conditions. Biomed Res Int. 2013;2013:127589. </li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Bao YK, Weide LG, Ganesan VC, et al. High prevalence of comorbid autoimmune diseases in adults with type 1 diabetes from the HealthFacts database. J Diabetes. 2019;11(4):273–279.</li>
 <li style="margin-left:8px">Hemminki K, Li X, Sundquist J, Sundquist K. Familial association between type 1 diabetes and other autoimmune and related diseases. Diabetologia. 2009;52(9):1820-8.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">Besser REJ, Bell KJ, Couper JJ, et al.&nbsp;ISPAD clinical practice consensus guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23:1175-87.</li>
 <li class="EndNoteBibliography" style="margin-top:8px; margin-bottom:8px; margin-left:8px">American Diabetes Association Professional Practice C. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S52–S76.</li>
</ol>

Individuals living with other associated autoimmune diseases like celiac disease or autoimmune thyroid disease, are at an increased risk of developing autoimmune type 1 diabetes (T1D) and should be appropriately screened.1-6

Does your patient have an existing autoimmune condition? Check for autoimmune type 1 diabetes! 

<h2>Is the pathogenesis of autoimmune T1D poorly understood?</h2>
The pathogenesis of autoimmune T1D involves a complex interaction between the beta cells and immune system.1 It begins when the autoreactive T cells recognize and destroy the pancreatic beta cells. This leads to a critical decline in insulin levels, which in turn causes ineffective control of blood glucose levels. Eventually, the remaining beta cells become insufficient to maintain normal blood glucose reducing insulin secretion and leading to autoimmune T1D.2 
Lately, many autoantigens responsible for triggering immune-mediated destruction of beta cells have been identified; however, the triggering factors for this autoimmune response remain poorly understood.2,3 &nbsp;
&nbsp;
Please hit the play button below to understand one of the potential mechanisms behind the triggering of the autoimmune response 
<h3 style="margin-top: 8px; margin-bottom: 8px;">A potential mechanism for triggering autoimmune response2</h3>

Autoimmune type 1 diabetes (T1D) is a progressive disease in which the decline in beta cell function usually begins months or sometimes years before clinical symptoms are observed.1–3 You can identify such patients at risk of developing autoimmune T1D before clinical symptoms are noticed by you or your patient.3

Can autoimmune type 1 diabetes be detected years before symptom onset?

<h2 style="margin-top: 8px; margin-bottom: 8px;">Does the onset of autoimmune T1D begin long before symptoms appear?</h2>
In general, autoimmune T1D is a disease continuum that progresses sequentially through identifiable stages before symptoms appear. The rate of progression of T1D from the stage of autoimmune response to symptomatic disease varies among individuals and may take from few months to decades.3

<h2>Genetic susceptibility and genetic risk detection of autoimmune T1D</h2>
It is noteworthy that people living with other associated autoimmune diseases, such as celiac disease, autoimmune thyroid disease, are at an increased risk of developing autoimmune T1D than the general population.4 Shared genetic risk factors and immune system dysregulation are potentially implicated both in polyautoimmunity (occurrence of ≥2 autoimmune diseases in a single patient) and family autoimmunity (presence of ≥2 autoimmune diseases in members of a nuclear family) among individuals with autoimmune T1D.5 
Currently, first- or second-degree relatives of individuals with autoimmune T1D or pediatric population are being screened for increased risk of developing autoimmune T1D in the research setting.3
&nbsp;
For additional information on common genetic risk factors linked to autoimmune T1D, please read this article.

Does your patient have an existing autoimmune condition? Check for autoimmune type 1 diabetes risk!

<h2>What are the stages of autoimmune T1D?</h2>
The Breakthrough T1D (formerly JDRF), the Endocrine Society, and the American Diabetes Association (ADA) have proposed three distinct stages of development and progression of autoimmune T1D, starting with the stage of activation of autoimmune response against the beta cells through symptomatic T1D.3 
<h3 style="margin-top: 8px; margin-bottom: 8px;">Progressive destruction of beta-cell function through different stages of autoimmune T1D3,6</h3>
In Stage 1, two or more autoantibodies against the pancreatic islets are detectible in the peripheral circulation which serve as a marker of autoimmunity. Beta-cell number and function begins to decline but are adequate to maintain normoglycemia.3
In Stage 2, progressive beta-cell damage compromises insulin production, and glycemic control cannot be maintained consistently, resulting in dysglycemia. Autoantibodies persist in the peripheral circulation.3
In Stage 3, beta-cell function is reduced such that blood glucose levels are consistently elevated and treatment with insulin is eventually required. Clinical symptoms of autoimmune T1D appear, including polyuria, polydipsia, weight loss, fatigue, and diabetic ketoacidosis (DKA).3
The below figure illustrates the three distinct stages of autoimmune T1D.

<h2>Can autoimmune T1D be identified before symptom onset?</h2>
Conventionally, autoimmune T1D is diagnosed after onset of clinical symptoms. However, latest research evidence on pathophysiological mechanisms leading to development and progression of T1D enable us to identify autoimmune T1D in its presymptomatic stages (Stage 1 and Stage 2 as described above).3 
Early detection of presymptomatic stages through screening for autoantibodies provides us with an opportunity to intervene, to delay and ultimately prevent the symptomatic manifestation of autoimmune T1D.3 
<h3 style="margin-top: 8px; margin-bottom: 8px;">Early identification of individuals at risk of autoimmune T1D has a range of potential benefits6,9–11</h3>
Please click on the play button below to explore the potential benefits!

Early detection of autoimmune T1D is possible. You can identify patients at risk months to years before clinical symptoms appear!1-3

References
<ol style="margin-top:8px; margin-bottom:8px">
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449–2462. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Marré ML, James EA, Piganelli JD. β cell ER stress and the implications for immunogenicity in type 1 diabetes. Front Cell Dev Biol. 2015;3:67. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association.&nbsp;Diabetes Care.&nbsp;2015;38(10):1964–1974.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Barker JM. Clinical review: Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab. 2006;91(4):1210–1217. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Głowińska-Olszewska B, Szabłowski M, Panas P, et al. Increasing co-occurrence of additional autoimmune disorders at diabetes type 1 onset among children and adolescents diagnosed in years 2010-2018-single-center study. Front Endocrinol (Lausanne). 2020;11:476.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Sims EK, Besser REJ, Dayan C, et al. Screening for type 1 diabetes in the general population: A status report and perspective. Diabetes. 2022;71(4):610–623.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Ziegler AG, Rewers M, Simell O, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. JAMA. 2013;309:2473–2479.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Krischer JP; Type 1 Diabetes TrialNet Study Group. The use of intermediate endpoints in the design of type 1 diabetes prevention trials. Diabetologia. 2013;56:1919–1924.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Narendran P. Screening for type 1 diabetes: Are we nearly there yet? Diabetologia. 2019;62(1):24–27.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Besser REJ, Bell KJ, Couper JJ, et al. ISPAD clinical practice consensus guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1175–1187.​</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Hummel S, Carl J, Friedl N, et al. Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation. Diabetologia. 2023;66(9):1633–1642.</li>
</ol>

Autoimmune type 1 diabetes (T1D) is a progressive disease in which the decline in beta cell function usually begins months or sometimes years before clinical symptoms are observed.1–3 You can identify such patients at risk of developing autoimmune T1D before clinical symptoms are noticed by you or your patient.3

<h2 style="margin-bottom: 11px;">Why screen for autoantibodies?</h2>
Autoimmune T1D is associated with the appearance of autoantibodies many months or years before symptom onset.1 Decline in beta-cell function occurs in three distinct stages and by the time clinical symptoms manifest, significant beta-cell loss has typically occurred.1,2 Screening for autoantibodies is important for early detection of beta-cell destruction and provides patients/caregivers with opportunity to access healthcare providers to help them prepare and develop skills for better management of T1D.2,5,6 The autoantibodies detected in autoimmune T1D include:1,2
<ul style="margin-bottom:11px">
 <li style="margin-left:8px">Glutamic acid decarboxylase antibodies (GADA)</li>
 <li style="margin-left:8px">Insulinoma-associated-2 autoantibodies (IA-2A)</li>
 <li style="margin-left:8px">Insulin autoantibodies (IAA)</li>
 <li style="margin-bottom:11px; margin-left:8px">Zinc transporter 8 autoantibodies (ZnT8A) &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</li>
</ul>
<h3 style="margin-bottom: 11px;">Stages of autoimmune T1D depicting progressing beta-cell function decline2</h3>

Anti-islet autoantibodies that target proteins associated with beta-cells serve as biomarkers of autoimmune type 1 diabetes (T1D) development.1 The number of detectable autoantibodies through screening correlates with risk of developing autoimmune T1D.2 Assays for detecting autoimmune T1D have shown high sensitivity and specificity.3,4 &nbsp;

Need to identify risk of developing autoimmune type 1 diabetes? Test for autoantibodies!

<h2 style="margin-bottom: 11px;">How the presence of islet autoantibody determines risk of T1D?</h2>
The number of detectable autoantibodies through screening correlates with risk of developing autoimmune T1D.2,6 The majority of individuals with a single autoantibody do not progress to autoimmune T1D.7 However, presence of two or more autoantibodies increases the risk of progression to clinical T1D to 70% over 10 years and 100% over lifetime.6 
<h3 style="margin-bottom: 11px;">Risk of progression to autoimmune T1D after seroconversion to islet autoantibody positivity6</h3>

<h2>Who should be screened for islet autoantibodies?</h2>
Individuals with a family history of T1D are at greater risk of developing the disease, with up to a 15-fold increased risk if a first-degree relative has T1D.5 Additionally, individuals with certain other associated autoimmune diseases (e.g., celiac disease and autoimmune thyroiditis) and adults with abnormal glucose levels with a low BMI (&lt;25 kg/m2) or aged &lt;35 years are also likely to develop T1D.9,10.&nbsp;

Explore the connection between autoimmune T1D and other associated autoimmune conditions

<h2>What is right age for screening for autoimmune T1D?</h2>
Although T1D can manifest at any age, it most commonly occurs in children, teenagers, or young adults.1,11 Autoantibodies often emerge before the age of 6, even in cases where T1D is diagnosed much later in childhood. Screening for islet autoantibodies at ages of 2 and 6 has proven to be sensitive and efficient in predicting autoimmune T1D.12

<h2>What are the benefits of screening for autoimmune T1D?</h2>
Screening shows that approximately 95% of relatives of individuals with T1D test negative for autoantibodies, which can provide reassurance, especially to families with an affected member.5
In individual who test positive for autoantibodies, screening leads to early detection of autoimmune T1D, which in turn: 6
<ul>
 <li>Can prevent diabetes ketoacidosis, a life-threatening complication of diabetes.</li>
 <li>Provide preparation time to patients and caregivers to develop skills to manage T1D.</li>
 <li>Enable access to medical care to provide ongoing education and monitoring.</li>
</ul>

Know more about the monitoring of people screened positive for ≥1 islet autoantibodies

Widespread screening for autoimmune T1D is critical for early identification of at-risk individuals, thereby reducing the complications at diagnosis and guiding targeted interventions to manage and potentially dealy disease progression.13

References
<ol>
 <li style="margin-left:8px">Katsarou A, Gudbjörnsdottir S, Rawshani A, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016.</li>
 <li style="margin-left:8px">Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: A scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38(10):1964-1974.</li>
 <li style="margin-left:8px">Tiberti C, Yu L, Lucantoni F, et al. Detection of four diabetes specific autoantibodies in a single radioimmunoassay: an innovative high-throughput approach for autoimmune diabetes screening. Clin Exp Immunol. 2011;166(3):317-324.&nbsp;​</li>
 <li style="margin-left:8px">Cortez FJ and Gebhart D, Robinson PV, et al. Sensitive detection of multiple islet autoantibodies I type 1 diabetes using small sample volumes by agglutination-PCR. PLoS One. 2020;15(11):e0242049.</li>
 <li style="margin-left:8px">Sims EK, Besser REJ, Dayan C, et al; NIDDK Type 1 Diabetes TrialNet Study Group. Screening for type 1 diabetes in the general population: A status report and perspective. Diabetes. 2022;71(4):610-623. </li>
 <li style="margin-left:8px">Simmons KM and Sims EK. Screening and prevention of type 1 diabetes: Where are we? J Clin Endocrinol Metab. 2023;108(12):3067-3079. </li>
 <li style="margin-left:8px">DiMeglio LA, Evans-Molina C and Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449–2462.&nbsp;&nbsp; </li>
 <li style="margin-left:8px">Ziegler AG and Nepom GT. Prediction and pathogenesis in type 1 diabetes. Immunity. 2010;32(4):468-78. </li>
 <li style="margin-top:8px; margin-left:8px">Makimattila S, Harjutsalo V, Forsblom C, et al. Every fifth individual with type 1 diabetes suffers from an additional autoimmune disease: a Finnish nationwide study. Diabetes Care. 2020;43(5):1041-1047.</li>
 <li style="margin-top:8px; margin-left:8px">American Diabetes Association. Standards of care in diabetes—2024. Diabetes Care. 2024;47(suppl 1):S1-S321.</li>
 <li style="margin-left:8px">You W-P and Henneberg M. Type 1 diabetes prevalence increasing globally and regionally: The role of natural selection and life expectancy at birth. BMJ Open Diabetes Research and Care. 2016;4:e000161. </li>
 <li style="margin-left:8px">Ghalwash M, Dunne JL, Lundgren M, et al. Two-age islet-autoantibody screening for childhood type 1 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol. 2022;10(8):589-596.</li>
 <li style="margin-top:8px; margin-left:8px">Greenbaum CJ. A Key to T1D Prevention: Screening and monitoring relatives as part of clinical care. Diabetes. 2021;70:1029–1037.</li>
</ol>

Anti-islet autoantibodies that target proteins associated with beta-cells serve as biomarkers of autoimmune type 1 diabetes (T1D) development.1 The number of detectable autoantibodies through screening correlates with risk of developing autoimmune T1D.2 Assays for detecting autoimmune T1D have shown high sensitivity and specificity.3,4

* Consensus report endorsed by EASD, ADA, AACE, ACD, ADCES, ADS, ISPAD, ATTD, DiaUnion, the Endocrine Society and JDRF International.

<h2>What are the next steps for individuals who test positive for T1D autoantibodies?</h2>
A positive screening for presence of ≥2 autoimmune T1D antibodies indicate that the individual is in presymptomatic stage of autoimmune T1D.2 As per the latest consensus guidance, such individuals need metabolic monitoring for the presence of glucose abnormalities, an indicator of disease progression.1,3,4
Presence of dysglycemia, (fasting plasma glucose ≥100 mg/dL [≥5.6 mmol/L], 2-hour plasma glucose with 75 gm OGTT ≥140 mg/dL [≥7.8 mmol/L], 30/60/90 min glucose ≥200 mg/dL [≥11.1 mmol/L], and/or HbA1c ≥5.7% [≥39 mmol/mol]), in individuals who test positive for ≥2 autoimmune T1D antibodies indicate Stage 2 autoimmune T1D.3 Individuals in this stage have a 100% risk of progressing to symptomatic Stage 3 autoimmune T1D within the next 15 years.2 At this stage (Stage 2) you can provide such individuals and their caregivers the relevant disease-related education and psychosocial support needed to prepare for a possible Stage 3 autoimmune T1D diagnosis. 4,5

<h2 style="margin-top: 8px; margin-bottom: 8px;">What is the purpose of monitoring T1D autoantibodies and glycemia?</h2>
The primary purpose of monitoring individuals with positive screening results for autoimmune T1D antibodies is to potentially lower the risk of diabetic ketoacidosis (DKA) at Stage 3 autoimmune T1D diagnosis.1 DKA is a life-threatening condition which is associated with need for hospital admission and potential long-term complications.1 A lower risk of DKA is associated with lower incidence of severe hypoglycemic events within 10 years post diagnosis.1&nbsp; Regular medical monitoring, including monitoring glucose abnormalities, will help identify disease progression early on.1,4
Timely monitoring that helps in the early detection of Stage 3 autoimmune T1D can enable you to promptly initiate early insulin therapy which will help to optimize HbA1c and potentially avoid long-term consequences of prolonged hyperglycemia.1 Monitoring further avoids misdiagnosis of type 2 diabetes and delay in treatment, and also it may increase patient referrals to clinical trials where appropriate.1

<h2>Should you follow specific algorithms and tools to monitor individuals who test positive for T1D autoantibodies?</h2>
Monitoring of individuals who screened positive for islet autoantibodies can be largely divided into the two categories:
<ul>
 <li>Repeat antibody testing: Once an individual tests positive, the second confirmatory test should be done within 3 months.1 A persistent presence of &gt;1 autoantibody indicates presymptomatic Stage 1 autoimmune T1D.1 Repeat periodic assessments confirming presence of ≥2 autoantibodies along with onset of dysglycemia indicates progression of disease to Stage 2 autoimmune T1D.1&nbsp;</li>
 <li>Metabolic monitoring: Choose from multiple available tools, such as regular oral glucose tolerance test (OGTT), random venous or capillary blood glucose, continuous glucose monitoring (CGM), HbA1c testing or self-monitoring of blood glucose (SMBG).1 Testing C-peptide can help you assess measure of beta-cell function and distinguish stages of T1D.1</li>
</ul>
A detailed description of the methods used for metabolic monitoring is provided in the table below.
<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">
 <tbody>
 <tr>
 <td style="background-color: rgb(112, 34, 221);">Metric</td>
 <td style="background-color: rgb(112, 34, 221);">
 Pros</td>
 <td style="background-color: rgb(112, 34, 221);">Cons</td>
 <td style="background-color: rgb(112, 34, 221);">Information gained</td>
 </tr>
 <tr>
 <td style="background-color: rgb(245, 245, 245);">Oral glucose tolerance test (OGTT)4</td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Gold standard</li>
 <li>Used to stage disease and predict progression</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Requires glucose load and 2 to 5 blood draws over 2 hours</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Glycemic staging</li>
 <li>Risk scores for progression</li>
 <li>(DPTRS, DPTRS60, Index60, M120)</li>
 </ul></td>
 </tr>
 <tr>
 <td>Random venous glucose4,6</td>
 <td>
 <ul>
 <li>One-off sample</li>
 <li>Low cost</li>
 </ul></td>
 <td>
 <ul>
 <li>Requires a blood draw</li>
 </ul></td>
 <td>
 <ul>
 <li>Similar to 2-hour OGTT-derived glucose</li>
 </ul></td>
 </tr>
 <tr>
 <td style="background-color: rgb(245, 245, 245);">HbA1c4</td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Highly specific</li>
 <li>Can use capillary sample</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Insensitive, often normal in asymptomatic or recent onset Stage 3 diabetes, may be affected by disease states</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Risk of progression to "clinical disease": HbA1c or 10% rise over 3-12 months</li>
 </ul></td>
 </tr>
 <tr>
 <td>Continuous Glucose monitoring (CGM)</td>
 <td>
 <ul>
 <li>Use at home</li>
 </ul></td>
 <td>
 <ul>
 <li>Optimal duration and frequency of CGM wear not yet determined</li>
 <li>Cost and access issues</li>
 </ul></td>
 <td>
 <ul>
 <li>Risk of progression to "clinical disease" 10% &gt;7.8mmol/L (&gt;140 mg/dl)</li>
 <li>Realtime monitoring over 24 hours</li>
 </ul></td>
 </tr>
 <tr>
 <td style="background-color: rgb(245, 245, 245);">Self monitoring blood glucose (SMBG)4</td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Simple use at home</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Optimal timing and frequency have not been determined, unconfirmed glucose values</li>
 </ul></td>
 <td style="background-color: rgb(245, 245, 245);">
 <ul>
 <li>Immediate result</li>
 </ul></td>
 </tr>
 </tbody>
</table>
At any point of monitoring if you observe onset of hyperglycemia along with other clinical symptoms such as polyuria, polydipsia, weight loss, fatigue, hunger, blurry vision, and diabetic ketoacidosis (DKA), it indicates disease progression to symptomatic Stage 3 autoimmune T1D.1
The <a href="https://link.springer.com/article/10.1007/s00125-024-06205-5" style="color:#0563c1; text-decoration:underline">consensus guidance published in June 2024</a> provides a detailed algorithm for monitoring of individuals who have been screened positive for islet autoantibodies.1 Below figure illustrates an algorithm for monitoring of people screened positive for ≥2 islet autoantibodies.1
<h3 style="margin-top: 8px; margin-bottom: 11px;">Decision path for monitoring of individuals screened positive for ≥1 islet autoantibodies1</h3>

Individuals who screen positive for ≥1 autoimmune islet cell antibodies need periodic medical monitoring, which includes regular assessments of blood glucose and HbA1c levels. You can also educate them about symptoms of diabetes, diabetic ketoacidosis (DKA), and provide psychosocial support to prepare them for a possible clinical diagnosis for type 1 diabetes (T1D).1

How should individuals with positive autoimmune T1D autoantibodies be monitored over time?  

*Monitoring frequency and methodology depends on age, length of time since first detection of islet autoantibody, number of islet autoantibodies detected and presence of symptoms of type 1 diabetes

<h3 style="margin-top: 16px;">Are there any differences in metabolic monitoring approach in children versus adults?</h3>
Progression of autoimmune T1D among islet autoantibody-positive adults is slower than children, which is why there are minor variations in monitoring approaches.1 You can follow a more frequent metabolic monitoring for children compared to adults.1 Also, children who have progressed to Stage 2 autoimmune T1D need to be followed up in a specialty care setting.1 Refer to the figure below for more details.

<h2>Where should the monitoring be conducted?</h2>
Monitoring should be conducted wherever there are the necessary skills and resources to perform the required tests. Early stage (Stage 1 T1D) monitoring can be done in primary-care setting. As soon as you observe indicators of progression of disease to Stage 2 autoimmune T1D i.e. onset of glucose abnormalities, consider referring to specialty care provider. 1 &nbsp;

Monitoring individuals who test positive for autoimmune T1D antibodies is crucial to reduce the risk of DKA and minimize the need for emergency care and hospitalization1

References
<ol style="margin-bottom:11px">
 <li style="margin-left:8px">Phillip M, Achenbach P, Addala A, et al. Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes. Diabetologia. Published online June 24, 2024. doi:10.1007/s00125-024-06205-5</li>
 <li style="margin-left:8px">Mameli C, Triolo TM, Chiarelli F, Rewers M, Zuccotti G, Simmons KM. Lessons and gaps in the prediction and prevention of type 1 diabetes. Pharmacol Res. 2023;193:106792. doi:10.1016/j.phrs.2023.106792 </li>
 <li style="margin-left:8px">Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38(10):1964-1974. doi:10.2337/dc15-1419</li>
 <li style="margin-left:8px">Besser REJ, Bell KJ, Couper JJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1175-1187 </li>
 <li style="margin-left:8px">Greenbaum CJ. A Key to T1D Prevention: Screening and Monitoring Relatives as Part of Clinical Care. Diabetes. 2021;70(5):1029-1037. doi:10.2337/db20-1112</li>
 <li style="margin-bottom:11px; margin-left:8px">Helminen O, Aspholm S, Pokka T, et al. OGTT and random plasma glucose in the prediction of type 1 diabetes and time to diagnosis. Diabetologia. 2015;58(8):1787-1796.</li>
</ol>

<h2>ADA guideline recommendations for screening of autoimmune diseases in autoimmune T1D</h2>
Individuals with an existing autoimmune disease are more prone to develop other associated autoimmune diseases.4-6,10 
The <a href="https://diabetesjournals.org/care/article/47/Supplement_1/S52/153956/4-Comprehensive-Medical-Evaluation-and-Assessment" style="color:#0066ff; text-decoration:underline">2024 ADA guidelines on Comprehensive Medical Evaluation and Assessment of Comorbidities</a> recommend screening for autoimmune thyroid disease soon after a T1D diagnosis and periodically, thereafter. Additionally, screening for celiac disease is recommended in the presence of gastrointestinal symptoms, signs, laboratory manifestations, or suspicion of celiac disease.10
To learn more about screening for autoantibodies to identify individuals at risk for autoimmune T1D, click <a>here.</a>

Individuals who screen positive for ≥1 autoimmune islet cell antibodies need periodic medical monitoring, which includes regular assessments of blood glucose and HbA1c levels. You can also educate them about symptoms of diabetes, diabetic ketoacidosis (DKA), and provide psychosocial support to prepare them for a possible clinical diagnosis for type 1 diabetes (T1D).1

<h2>Can screening for T1D autoantibodies help prevent DKA?</h2>
Anti-islet autoantibodies, responsible for destruction of insulin-producing beta-cells, can be detected during the presymptomatic phase (Stage 1 and 2) of autoimmune T1D. If left undetected, there is progression from the presymptomatic phase to symptomatic phase (Stage 3), which is characterized by beta-cell functional loss and hyperglycemia, which may often lead to ketoacidosis.6
<h3>Stages of autoimmune type 1 diabetes6</h3>

Delay in screening for autoimmune type 1 diabetes (T1D) can increase the risk of diabetic ketoacidosis (DKA) at diagnosis—a critical complication that is potentially life-threatening and may result in long-term poor glycemic control and neurological complications.1,2 By identifying autoimmune T1D early, you can significantly lower the risk of DKA at diagnosis.3,4

Early detection of autoimmune type 1 diabetes could reduce the risk of diabetic ketoacidosis

Know more about different stages of autoimmune T1D

Click here to know more about different stages of autoimmune T1D.
Screening for beta-cell autoantibodies in high-risk individuals allows for early diagnosis of T1D, timely intervention through monitoring and treatment, and prevention of complications such as DKA.1,6 Moreover, preventing DKA through screening results in reduced DKA-associated morbidity, mortality, and healthcare cost.4

<h3>Benefits of early T1D screening2,4</h3>

<h2>Is DKA a critical risk for children with T1D?</h2>
Diabetic ketoacidosis is a critical complication and the leading cause of hospitalization in children with autoimmune T1D. It accounts for 70% of diabetes-related deaths in those under 10 years, often due to cerebral edema.5,7&nbsp;
Type 1 diabetes is often diagnosed following a DKA event. The incidence of DKA at the onset of T1D varies worldwide, ranging from 15% to 80%.8 Diabetic ketoacidosis at the diagnosis of autoimmune T1D significantly worsens glycemic control by potentially accelerating beta-cell loss. Additionally, children who experience DKA may face long-term cognitive complications, impairing their ability to engage in self-care.2

<h2>Who is at risk of DKA?</h2>
Diabetic ketoacidosis predominantly affects people with T1D but can also occur in those with type 2 diabetes. Common triggers in both populations include catabolic stress from:9
<ul>
 <li>Acute illnesses and injuries</li>
 <li>Surgery</li>
 <li>Infections</li>
 <li>Non-compliance with treatment</li>
 <li>New-onset diabetes</li>
 <li>Other acute medical conditions</li>
</ul>
The risk of DKA is notably higher among younger children with T1D.1 It is concerning that T1D diagnosis in children under 5 years often coincides with DKA. The reported prevalence of DKA in this age group at diagnosis ranges from 17.3% to 54.5%.4 Recognizing signs and symptoms in these children can be particularly challenging, potentially leading to delayed diagnosis.1
<h3>Risk of DKA by age1</h3>

Children of siblings of individuals with T1D show the lowest rate of DKA, highlighting the importance of parental awareness regarding diabetes signs and symptoms.2

<h2>What is the pathogenesis of DKA?</h2>
Autoimmune T1D, resulting from the destruction of pancreatic beta-cells, causes insulin deficiency. Insulin deficiency, coupled with increased counterregulatory hormones, triggers the release of free fatty acids from adipose tissue. These fatty acids are then oxidized in the liver to form ketone bodies, leading to ketoacidosis. This ultimately causes worsening of hyperglycemia, as illustrated in the below figure.5,9
<h3>Pathogenesis of DKA10</h3>

<h2>How is DKA evaluated?</h2>
Diabetic ketoacidosis can be evaluated through both clinical signs and laboratory tests. Clinically, DKA manifests with symptoms such as polyuria, polydipsia, hyperglycemia, weight loss and acetone breath.11
<h3>Symptoms of DKA11</h3>

In addition to clinical signs, DKA is characterized by specific laboratory findings, with the presence of:5
<ul style="margin-top:8px; margin-bottom:8px">
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Hyperglycemia (blood glucose &gt;200 mg/dL),</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Metabolic acidosis (venous pH &lt;7.3 or serum bicarbonate concentration 
 &lt;15 mEq/L), and </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Ketonemia or moderate/high ketonuria</li>
</ul>
The severity of DKA is primarily determined by the degree of acidosis observed in these laboratory parameters, as depicted in below table.5 
<h3 style="margin-top: 8px; margin-bottom: 8px;">Diabetic ketoacidosis severity classification5</h3>
<table align="center" border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td style="background-color: rgb(112, 34, 221);">&nbsp;</td>
 <td style="background-color: rgb(112, 34, 221);">
 Mild</td>
 <td style="background-color: rgb(112, 34, 221);">Moderate</td>
 <td style="background-color: rgb(112, 34, 221);">Severe</td>
 </tr>
 <tr>
 <td>Serum pH</td>
 <td style="text-align: center;">7.2-7.3</td>
 <td style="text-align: center;">7.0-7.2</td>
 <td style="text-align: center;">&lt;7.0</td>
 </tr>
 <tr>
 <td style="border-bottom:1px solid black; width:204px; padding:0cm 7px 0cm 7px; height:25px; border-top:1px solid black; border-right:1px solid black; border-left:1px solid black">
 Serum HCO3 (mEq/L)</td>
 <td style="text-align: center;">15–18</td>
 <td style="text-align: center;">10–15</td>
 <td style="text-align: center;">&lt;10</td>
 </tr>
 </tbody>
</table>
HCO3, bicarbonate

DKA is a life-threatening condition often associated with high mortality, morbidity, and healthcare expenditure. Early screening and detection of T1D are crucial for preventing DKA1,5

References
<ol style="margin-top:8px; margin-bottom:8px">
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Cherubini V, Grimsmann JM, Åkesson K, et al. Temporal trends in diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes between 2006 and 2016: results from 13 countries in three continents. Diabetologia. 2020;63(8):1530-1541. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Duca LM, Wang B, Rewers M, and Rewers A. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care. 2017;40(9):1249-1255. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Nakhla M, Cuthbertson D, Becker DJ, et al. Diabetic ketoacidosis at the time of diagnosis of type 1 diabetes in children: insights from TRIGR. JAMA. 2021;175(5):518-520. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Elding Larsson H, Vehik K, et al. TEDDY Study Group; SEARCH Study Group; Swediabkids Study Group; DPV Study Group; Finnish Diabetes Registry Study Group. Reduced prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in young children participating in longitudinal follow-up. Diabetes Care. 2011;34(11):2347-2353.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Bonadio W. The evaluation and management of pediatric diabetic ketoacidosis: A comprehensive review. Clinical Pediatrics. 2024; 62 (6):551-564.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Sims EK, Besser REJ, Dayan C, et al; NIDDK type 1 diabetes TrialNet study group. Screening for type 1 diabetes in the general population: A status report and perspective. Diabetes. 2022;71(4):610-623.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Wolfsdorf J, Craig ME, Daneman D, et al. Diabetic ketoacidosis. Pediatric Diabetes. 2007;8(1):28-42.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Simmons KM and Sims EK. Screening and prevention of type 1 diabetes: Where are we? J Clin Endocrinol Metab. 2023;108(12):3067-3079.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Lizzo JM, Goyal A, and Gupta V. Adult diabetic ketoacidosis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: <a href="https://www.ncbi.nlm.nih.gov/books/NBK560723/" style="color:#0563c1; text-decoration:underline" target="_blank" title="https://www.ncbi.nlm.nih.gov/books/NBK560723/">https://www.ncbi.nlm.nih.gov/books/NBK560723/</a>. Accessed on 10 Jul 2024. </li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Algarni A. Treatment considerations and pharmacist collaborative care in diabetic ketoacidosis management. J Pharmacol Pharmacother. 2022;13(3):215–221.</li>
 <li style="margin-top:8px; margin-bottom:8px; margin-left:8px">Lee CS and Rickard J. Review of diabetic ketoacidosis management. USPharm. 2018;43(11):26-28.</li>
</ol>

Delay in screening for autoimmune type 1 diabetes (T1D) can increase the risk of diabetic ketoacidosis (DKA) at diagnosis—a critical complication that is potentially life-threatening and may result in long-term poor glycemic control and neurological complications.1,2 By identifying autoimmune T1D early, you can significantly lower the risk of DKA at diagnosis.3,4

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Latest Articles

Real-life stories from people living with autoimmune T1D

Real-life stories from people living with autoimmune T1D

Does your patient have an existing autoimmune condition? Check for autoimmune type 1 diabetes!

Can autoimmune type 1 diabetes be detected years before symptom onset?

Need to identify risk of developing autoimmune type 1 diabetes? Test for autoantibodies!

How should individuals with positive autoimmune T1D autoantibodies be monitored over time?

Early detection of autoimmune type 1 diabetes could reduce the risk of diabetic ketoacidosis