FOR HEALTHCARE PROFESSIONALS ONLY
  1. Article
  2. Source: Campus Sanofi
  3. Jun 19, 2025

Screening for autoimmune type 1 diabetes using autoantibodies

Author: Sanofi

Editorial team

Early screening for type 1 diabetes autoantibodies enables the identification of individuals at risk before symptoms appear, allowing for timely intervention and disease management.1 Anti-islet autoantibodies that target proteins associated with beta-cells serve as biomarkers of autoimmune type 1 diabetes (autoimmune T1D) development.2 The number of detectable autoantibodies through screening correlates with the risk of developing autoimmune T1D.2 Assays for detecting autoimmune T1D have shown high sensitivity and specificity.3
Why are autoantibodies important in autoimmune T1D screening?What is the difference between autoimmune type 1 vs type 2 diabetes screening?What is the right age for autoimmune T1D screening?What are the benefits of early screening for autoimmune T1D?Prevention of misdiagnosis and delayed treatmentEarly treatment and glycemic controlReduced risk of diabetic ketoacidosis (DKA) at diagnosisPreparing patients and families for autoimmune T1D managementPocket guide on who to screen for autoimmune T1D

Why are autoantibodies important in autoimmune T1D screening?

Autoantibodies are measurable biomarkers that appear months or even years before symptoms of autoimmune T1D develop and serve as key indicators of early beta-cell destruction.4 Screening for these biomarkers allows for the early identification of individuals at risk of developing autoimmune T1D, enabling caregivers to prepare for timely intervention and potentially preventing or delaying the onset of the disease.1,5

Blood tests like the diabetes mellitus autoantibody panel (also called the islet autoantibody test) can detect autoantibodies targeting insulin-producing cells, helping to differentiate autoimmune T1D from other forms.6 This early detection is particularly critical because autoimmune T1D progresses in distinct stages, often leading to significant beta-cell loss by the time symptoms appear.1

Many individuals with a single autoantibody do not progress to autoimmune T1D. However, the presence of two or more autoantibodies increases the risk of progression to clinical autoimmune T1D to 70% over 10 years and 100% over a lifetime.2,7

The autoantibodies detected in autoimmune T1D include:

  • Glutamic Acid Decarboxylase Antibodies (GADA)8
  • Insulinoma-associated-2 Autoantibodies (IA-2A)8
  • Insulin Autoantibodies (IAA)8
  • Zinc Transporter 8 Autoantibodies (ZnT8A)8

Screening for these offers significant insight into the pathogenesis of immune-mediated diabetes. Learn more about the clinical significance of these autoantibodies in autoimmune T1D.

The presence of multiple autoantibodies not only confirms the likelihood of beta-cell destruction but also significantly enhances the ability to predict autoimmune T1D progression. Screening panels that identify two or more autoantibodies offer an accurate assessment of risk, helping to identify individuals who may benefit from closer monitoring and potential intervention.2

Risk of progression to autoimmune T1D after seroconversion to islet autoantibody positivity7

What is the difference between autoimmune type 1 vs type 2 diabetes screening?

Type 1 diabetes is an autoimmune disease-causing islet cell destruction, while type 2 diabetes results from insulin resistance. Due to these differences, screening for aT1D and type 2 diabetes varies in target populations, tests, frequency, and goals.9

Parameters

Autoimmune T1D

T2D
Target populations Children and adolescents, especially those with a family history of autoimmune T1D or other autoimmune conditions. Rising incidence in children under five. Adults over 18 can also develop autoimmune T1D at equal rates.1Adults, particularly those with risk factors such as obesity, hypertension, physical inactivity, or a family history of T2D.9
Screening tests and biomarkersAutoantibody tests, such as the diabetes mellitus autoantibody panel, to detect markers of autoimmune beta-cell destruction.8Fasting plasma glucose, A1C, HbA1c, and oral glucose tolerance tests to assess insulin resistance and glucose metabolism.9
Frequency of screeningChildren with a family history of autoimmune disease should be screened every 3 years to annually until age 18. Adults generally require no additional screening unless symptomatic. Positive results require follow-up with a diabetes expert, with children monitored at intervals and adults screened every 3-5 years only if there’s a family history of autoimmune disease.11Screening is recommended every 3 years if normal results are found, especially for those aged 40-70 who are overweight or obese. Those with multiple risk factors may need annual or more frequent tests.9
Screening goalsIdentify high-risk individuals through diabetes-related autoantibody testing to enable early interventions or clinical trial opportunities to preserve beta-cell function and delay disease onset.11Identify asymptomatic individuals at risk to enable early interventions (lifestyle changes, medications) that can delay disease progression and reduce adverse outcomes like cardiovascular disease.9

What is the right age for autoimmune screening?

Although autoimmune T1D can manifest at any age, it most commonly occurs in children, teenagers, or young adults.1 Autoantibodies often emerge before the age of 6, even in cases where autoimmune 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

Current type 1 diabetes guidelines provide specific recommendations on the age ranges and risk factors for autoimmune T1D screening.

Schema to identify when to screen

What are the benefits of early screening for autoimmune T1D?

Early screening for autoimmune T1D autoantibodies in individuals at risk, such as those with a family history of autoimmune T1D or related autoimmune conditions like celiac disease offers critical advantages.11 Learn more about etiology and risk factors for autoimmune T1D.

Early detection presents a significant opportunity to prevent the natural progression of autoimmune T1D and preserve beta cell function.5

Screening shows that approximately 95% of relatives of individuals with autoimmune T1D test negative for autoantibodies, which can provide reassurance, especially to families with an affected member.13

In individuals who test positive for autoantibodies, screening leads to early detection of autoimmune T1D7, which in turn provides critical advantages, such as:

Prevention of misdiagnosis and delayed treatment

Autoimmune T1D screening helps prevent misdiagnosis and delayed treatment by identifying the disease in adults, where it is often misdiagnosed, especially in those not requiring insulin at diagnosis. Early detection allows for proper staging, preserving endogenous insulin production, and enabling timely access to therapies like immunotherapy, especially in individuals with a family or personal history of autoimmune conditions.11

Early treatment and glycemic control

Autoimmune T1D screening contributes to glycemic control by allowing early interventions that address challenges such as the loss of counterregulatory mechanisms and hypoglycemia unawareness. Early diagnosis helps manage these risks more effectively and supports treatments that maintain target blood sugar levels while minimising the risk of hypoglycemia and associated barriers.1

Reduced risk of diabetic ketoacidosis (DKA) at diagnosis

Detecting multiple T1D autoantibodies early reduces the risk of life-threatening complications like diabetic ketoacidosis (DKA) at symptom onset.7

Preparing patients and families for autoimmune T1D management

Early screening provides patients and their families with valuable time to prepare for autoimmune T1D, enabling a smoother transition if symptoms develop.7 Uncover the real-life stories of patients living with autoimmune T1D.

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

Learn more about how to monitor individuals with positive autoantibodies over time and download our resource on who to screen for further guidance.

References

  1. Cherubini V, Chiarelli F. Autoantibody test for type 1 diabetes in children: are there reasons to implement a screening program in the general population? A statement endorsed by the Italian Society for Paediatric Endocrinology and Diabetes (SIEDP-ISPED) and the Italian Society of Paediatrics (SIP). Ital J Pediatr. 2023;49(1):87. doi:10.1186/s13052-023-01438-3.

  2. 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.

  3. Gu Y, Zhao Z, Waugh K, et al. High-throughput multiplexed autoantibody detection to screen type 1 diabetes and multiple autoimmune diseases simultaneously. EBioMedicine. 2019;47:365-372. doi:10.1016/j.ebiom.2019.08.036.

  4. Katsarou A, Gudbjörnsdottir S, Rawshani A, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016. doi:10.1038/nrdp.2017.16.

  5. Al-Mulla F, Alhomaidah D, Abu-Farha M, et al. Early autoantibody screening for type 1 diabetes: a Kuwaiti perspective on the advantages of multiplexing chemiluminescent assays. Front Immunol. 2023;14:1273476. doi:10.3389/fimmu.2023.1273476.

  6. Winter WE, Pittman DL, Jialal I. Practical Clinical Applications of Islet Autoantibody Testing in Type 1 Diabetes. J Appl Lab Med. 2022;7(1):197-205. doi:10.1093/jalm/jfab113.

  7. Simmons KM, Sims EK. Screening and Prevention of Type 1 Diabetes: Where Are We?. J Clin Endocrinol Metab. 2023;108(12):3067-3079. doi:10.1210/clinem/dgad328.

  8. Kawasaki E. Anti-Islet Autoantibodies in Type 1 Diabetes. Int J Mol Sci. 2023;24(12):10012. doi:10.3390/ijms241210012.

  9. Pippitt K, Li M, Gurgle HE. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016;93(2):103-109. Available from: Diabetes Mellitus: Screening and Diagnosis | AAFP. Last accessed on May 26, 2025.

  10. Cinquanta L, Infantino M, Bizzaro N. Detecting Autoantibodies by Multiparametric Assays: Impact on Prevention, Diagnosis, Monitoring, and Personalized Therapy in Autoimmune Diseases. J Appl Lab Med. 2022;7(1):137-150. doi:10.1093/jalm/jfab132.

  11. Moore DJ, Leibel NI, Polonsky W, Rodriguez H. Recommendations for Screening and Monitoring the Stages of Type 1 Diabetes in the Immune Therapy Era. Int J Gen Med. 2024;17:3003-3014. doi:10.2147/IJGM.S438009.

  12. 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. doi:10.1016/S2213-8587(22)00141-3.

  13. 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. doi:10.2337/dbi20-0054.

MAT-GLB-2502137-1.0-05/2025  

Related