Imagine the terror of your child collapsing into a coma, rushed to the hospital, and diagnosed with a life-altering chronic illness – Type 1 Diabetes (T1D). This is the reality for thousands every year. But what if you could prevent this crisis? What if you could prepare, learn, and adjust before the emergency room visit? That's the power of early detection through autoantibody screening, a topic Dr. Shara Bialo passionately champions, especially during American Diabetes Month.
Dr. Shara Bialo, a senior medical director at Sanofi and a pediatric endocrinologist who herself lives with T1D, recently expanded on the vital benefits of early T1D detection in a conversation with Pharmacy Times®. As she emphasizes, catching T1D early isn't just about preventing diabetic ketoacidosis (DKA), a potentially deadly condition; it's about providing patients and their families with the invaluable gift of time to prepare for the inevitable insulin therapy and the significant lifestyle changes that come with it. You can find her initial discussion here: https://www.pharmacytimes.com/view/what-health-care-professionals-should-know-about-early-type-1-diabetes-screening.
While awareness of autoantibody screening is growing, Dr. Bialo points out some significant hurdles still limit its widespread adoption. These include clinician familiarity with the screening process, logistical challenges in integrating it into existing workflows, and concerns about insurance reimbursement. But here's where it gets controversial... some healthcare professionals also worry about the psychological impact of identifying a potential health problem before symptoms even appear. Dr. Bialo addresses these concerns directly, highlighting the crucial role pharmacists can play in reinforcing the importance of screening and educating families about the risks and preventative measures.
Pharmacy Times: What are the primary advantages of identifying T1D before the onset of symptoms or the need for insulin?
Dr. Shara Bialo, MD: Sadly, about 64,000 people are diagnosed with type one diabetes each year. And contrary to popular belief, the majority of these diagnoses occur in adults. It's a common misconception that type one diabetes only affects children. In children, a significant number present with diabetic ketoacidosis (DKA). DKA is a dangerous state where the body, unable to utilize glucose for energy, starts breaking down fats and producing ketones. This can be life-threatening if left untreated.
Adult-onset type one, while less frequent than in children, also carries the risk of DKA. People can experience significant complications and even death from DKA at the initial diagnosis of type one.
Screening allows us to intervene early with education and preparation. Numerous studies have demonstrated that screening and monitoring individuals at high risk of developing clinical type one can almost entirely eliminate DKA at onset. This is an enormous advantage. Imagine preventing a life-threatening crisis simply through proactive screening!
The other key benefit is simply time. Time is priceless. Many individuals receive their diagnosis during a medical emergency. I myself was diagnosed with DKA and was in a coma. My parents had to carry me into the hospital on that fateful day. It was a traumatic introduction to life with a chronic illness. They had very little time to understand what type one was, let alone absorb the information the medical team was providing. They were in crisis mode.
Detecting T1D on our own terms and timeline provides families with the opportunity to prepare clinically and psychologically for eventual insulin therapy. They can approach the situation at their own pace, learning and adjusting as needed. This can make a huge difference in their ability to cope with the diagnosis and manage the disease effectively. Think of it as the difference between being thrown into the deep end versus learning to swim with an instructor at your side.
Pharmacy Times: Despite increasing awareness, autoantibody screening is not yet a standard practice. What roadblocks are hindering broader adoption among healthcare professionals?
Dr. Bialo: That's an important question and a frequently discussed topic. There’s definitely more attention on type one diabetes screening than ever before, thanks to improvements in care and research that have created options for early T1D detection.
One major obstacle, despite all this activity, is clinician awareness. Many clinicians are not fully aware that type one diabetes exists in three distinct stages. They may not know that it can be detected early through autoantibody screening, how to order these tests, how to interpret the results, or understand the associated costs and reimbursement processes. There are also logistical and workflow constraints within daily clinical practice that make implementing routine screening challenging. It is a new paradigm and that takes time to implement.
Additionally, concerns persist regarding patient anxiety. Some worry that identifying an asymptomatic condition might cause undue stress. And this is the part most people miss... The data actually suggests that individuals fare better psychologically in the long run when they have time to prepare. Any initial anxiety is outweighed by the benefits of avoiding a crisis diagnosis and having time to adjust. So, while some clinicians worry about causing stress, the evidence suggests that early detection empowers individuals to manage their health proactively.
It wasn't until recently, within the past year or two, that we even had clear, consensus-based guidelines on how to medically manage individuals with autoantibody positivity. Now, we have concrete guidance on how to monitor these patients. This is a major step forward!
The field is strengthening in terms of resources, but broader guidelines will be helpful. We have guidance from diabetes-specific societies like the American Diabetes Association, which recommends offering screening to those at high risk—such as individuals with a family history of type one diabetes (who have up to a 15-times increased risk) and those with autoimmune diseases (who represent a good target population for screening). This is a great first step.
Ultimately, we need to move towards general population screening, since 90% of people with new-onset type one have no family history of the disease. Many steps remain to get there, but we're getting closer every day. This is ambitious, but it's where we need to be to truly impact the incidence and severity of T1D.
Pharmacy Times: How can pharmacists and other members of the healthcare team assist physicians in initiating or reinforcing screening discussions with patients and families?
Dr. Bialo: Pharmacists are invaluable medical partners. Patients and families affected by type one often interact with their pharmacists much more frequently than with their endocrinologists or primary care physicians. This presents a significant and fruitful opportunity for engagement and discussion.
One crucial role is identifying potential screening candidates based on family history, symptoms, and medications used. Pharmacists can also educate patients about the increased risk of developing type one among family members when there is a family history – again, up to a 15-times increased risk. This is a powerful message that can motivate families to take action.
By raising the topic and empowering patients and families to take the next step in screening their loved ones, pharmacists help them feel informed and supported. They can act as trusted advisors, guiding families through the complexities of T1D screening.
Repetition is also key. Much success in medicine stems from consistent, multi-faceted messaging. Patients have trusting relationships with their pharmacists. If they hear about type one diabetes screening from their pharmacist, and then again from their primary care physician or endocrinologist, that repeated exposure is more likely to drive action. It also reinforces the idea that the entire medical team is aligned and providing consistent recommendations. This creates a sense of confidence and encourages patients to take proactive steps to protect their health.
So, what are your thoughts? Should autoantibody screening for T1D be a standard practice for everyone, regardless of family history? Or do you believe the potential anxiety outweighs the benefits? Share your perspective in the comments below! Let's discuss the future of T1D detection together.
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