Justin Gregory, MD, MS, is the field medical director for autoimmune T1D at Sanofi.

Justin Gregory, MD, MS

Screening for Type 1 Diabetes in Adults: What Needs to Change

Contrary to longstanding beliefs, over half of all new 

 cases occur in adult patients, with different genetic, immune, and metabolic conditions than childhood T1D.

, Justin Gregory, MD, MPH, the field medical director for autoimmune T1D at Sanofi and a pediatric endocrinologist, and Steve Zortman, MPH, RN, the program manager of the Diabetes Education and Management Program at UVA Health, discussed the importance of frequent and in-depth screening and early recognition of T1D in adults.

“A real advantage of early detection is the opportunity for what I call the soft landing,” Gregory told 

. “In other words, contrast; you’ve been diagnosed in the hospital, you have multiple IVs in your body, and it’s such a horrible anxiety-provoking event. Contrast that with detecting it early, gradually easing you into living with type 1 diabetes in the sense that you’re doing more monitoring and more insulin therapy. Which would you prefer to have?”

The American Diabetes Association (ADA) Standards of Care in Diabetes 2025 highlight the critical importance of screening patients early and often for both biological and social determinants of metabolic health. The sooner T1D is caught in patients, the more time those patients have to adapt to regular monitoring and regulating of symptoms – waiting too long, on the other hand, naturally invites the risk of diabetic ketoacidosis or other complications.

Recent data have shown that adult-onset T1D may be more common than childhood-onset T1D, with some studies reporting similar incidence between individuals aged 0-19 years and those aged 40-100 years. Despite this, clinical practice and training have long focused on T1D as a childhood disease, often mistakenly categorizing adults as having 

Adults with T1D are also at an increased risk of other autoimmune conditions, with roughly 30% of patients also presenting with thyroid autoimmunity, and those with multiple islet autoantibodies are at an increased risk of progression to hypothyroidism. Additionally, adult patients are often diagnosed with C-peptide decline more frequently than children, attributed in part to a higher average body mass index (BMI).

The ADA’s guidelines primarily recommend HbA1c and fasting plasma glucose, among other methods, in screening for T1D, as well as detecting prediabetes. They also point out the fact that diabetes can manifest at any point along the spectrum of clinical presentations, from patients who appear low-risk to those with established symptoms. The document reemphasizes the need for early, frequent, and routine screening to protect these underrepresented adults with T1D.

Ultimately, Gregory and Zortman discuss the value of being conscious of the differences in presentation between autoimmune diabetes and typical T2D to avoid misdiagnosis and to provide optimal care for patients of all ages.

“Let’s imagine that you’re a family health doctor or a family practice doctor who mostly sees adults. You see so much type 2 that pattern recognition sets in,” Gregory said. “Let’s say you’ve already seen 9 patients who you’ve identified as having type 2 diabetes or prediabetes – pretty soon, everything starts to look like type 2 diabetes.”

Editors’ Note: Gregory reports disclosures with Sanofi, Medtronic, vTv Therapeutics, Beckman Coulter Inc., and DRI Capital, Inc. Zortman reports no relevant disclosures.

Leslie RD, Evans-Molina C, Freund-Brown J, et al. Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care. 2021;44(11):2449-2456. 

American Diabetes Association Professional Practice Committee; 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S14–S26. 

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Justin Gregory, MD, MPH, and Steve Zortman, MPH, RN, discuss the critical need for early detection and intervention in this underrepresented population.

Improving T1D Screening in Adult Men to Prevent Complications, With Justin Gregory, MD, MS

Despite the most recent standards of care in diabetes from the American Diabetes Association (ADA) emphasizing the importance of screening for 

, most men still go unscreened due to infrequent clinic visits.

In 2022, the Cleveland Clinic conducted a survey titled MENtion It, including 1000 US men aged ≥18 years. Based on this survey, roughly 55% of men do not undergo regular health screenings, and nearly 1 in 3 men have never been screened for various cancers or other diseases. This highlights the need for a significant overhaul in how screening is addressed, conducted, and discussed among male patients.

“I’d like for our field to move away from only reacting to disease once it’s apparent,” Justin Gregory, MD, MS, the field medical director for autoimmune T1D at Sanofi and a pediatric endocrinologist, told 

 in an exclusive interview. “If we get out in front of things and identify those disease processes before they’re really bad, outcomes can often improve. I’d like our field to start looking ahead, to see what we can identify at an early point to prepare for future issues.”

Despite historically being considered a childhood-onset disease, recent data have indicated the prevalence of adult-onset T1D worldwide. Adult T1D is also frequently associated with the typical 3 signs of childhood T1D, including elevated genetic risk, the presence of islet-specific autoantibodies, and progression to severe insulin deficiency. Given this wider awareness of adult T1D, recent publications have highlighted the need for more accurate methods of identifying the disease in this cohort.

Moreover, the preexisting conception of T1D as a childhood disease results in a substantial degree of misdiagnosis. Given that no individual clinical feature can fully distinguish between T1D and 

, many patients are assumed to have the latter, given the longstanding belief that the former presents solely in children. This can result in adult patients with T1D not knowing they have the disease until they eventually develop severe diabetic ketoacidosis (DKA), which can lead to significant complications later in life.

According to recent publications, T1D also presents more commonly in men versus women, indicating a greater need for improvements to screening among men. Gregory speaks to this as well, pointing out the value of optimizing the infrequent clinic visits common to a significant proportion of men. He emphasizes the value of early detection to drive home the need for further appointments and visits to manage the condition rather than allowing it to progress undetected.

“Let’s think about trying to detect that as early as possible, because if we do, we can potentially avoid a lot of the long-term consequences of having that condition and not knowing about it,” Gregory said. “I like to think in terms of getting on the same page about treatment goals, whether I’m the physician in the situation or the patient, so that the conversation can go in a productive direction from there.”

Editors’ Note: Gregory reports disclosures with Sanofi, Medtronic, vTv Therapeutics, Beckman Coulter Inc., and DRI Capital, Inc.

American Diabetes Association Professional Practice Committee; 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S27–S49. 

Buggey H, Ely K. Cleveland Clinic Survey Reveals Men’s Top Health Concerns as They Age. 

. September 7, 2022. Accessed July 8, 2026. 

https://newsroom.clevelandclinic.org/2022/09/07/cleveland-clinic-survey-reveals-mens-top-health-concerns-as-they-age

Evans-Molina C, Oram RA. Type 1 diabetes presenting in adults: Trends, diagnostic challenges and unique features. Diabetes Obes Metab. 2025;27 Suppl 6(Suppl 6):57-68. 

Gregory discusses his strategies for optimizing adult male patients’ typically infrequent clinic visits to identify and forestall T1D progression.

Justin Gregory, MD, MS

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