Best Practices for Screening and Diagnosis of Type 1 Diabetes in Pediatric Patients - Episode 5

Approaching T1D Screening Retesting

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Experts consider how often a patient with a family history of type 1 diabetes needs to be retested.

Tina Q. Tan, MD: One thing is that if a patient has a family history of type 1 diabetes [T1D] and the pediatrician decides they’re going to send off a screening test and the autoantibodies come back negative, how often should this patient be rescreened to monitor them for the potential development of type 1 diabetes?

Kimberly Simmons, MD: I think that is a question we don’t know the exact answer to. I think the study that I referenced earlier was looking at relatives mostly, and so, what are those time buckets where you’re going to catch most people? But you’re going to have patients that screen negative, and if you don’t plan to screen them for 3 more years, they’re going to become positive the next year. That’s part of what happens. Islet autoantibodies and that trigger can really happen at any time, and we don’t have enough understanding to say when the exact right time is to repeat testing. So, if resources are not limited, if somebody has a family history, you could say that maybe a yearly screen is OK. But if resources are limited, and to be more cost-effective, we probably need to think about what specific time points are most important.

Tina Q. Tan, MD: And if a pediatrician is screening 1 sibling, and that sibling comes back with potential positive autoantibodies, should they be screening all the other siblings? Because that’s a question that comes up frequently: How many of the siblings should be screened, and how often should all of them be screened?

Kimberly Simmons, MD: My thought would be: yes, if a sibling has islet autoantibodies, then their siblings are probably at risk, just as they would be at risk if they already had clinical type 1 diabetes. And part of that is because they share genetics, and part of that is because they share environment. We don’t know exactly why, but we know that their risk is higher, so it would make sense to screen the siblings of someone who is, really, in any stage of type 1 diabetes.

Transcript edited for clarity