Delaying the Onset of Type 1 Diabetes Through Early Intervention - Episode 6

Clinical Signs Leading to Diagnostic Testing for T1D

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Expert endocrinologists discuss the clinical symptoms that prompt testing for T1D, as well the diagnostic testing tools that are available in clinical practice.

Steve Edelman, MD: Schafer, this seems like a simple question, but let’s see what you can do with it. What are the clinical signs that should prompt testing for type 1 diabetes [T1D]? And what are the standard tests used for T1D detection? It sounds like this question goes a bit later in the natural history.

Schafer Boeder, MD: A lot of individuals watching this video can answer this question, but it’s good to think about. Ultimately, we talked about screening and when to screen, and a lot of that comes down to what you’re going to do about it. Until now, 1 of the things we care about is reducing the chance of going into DKA [diabetic ketoacidosis]—trying to catch it early. Whether you’re screened or not, there’s some risk there. It’s important to be aware of what these signs and symptoms of diabetes are: polyuria, polydipsia, losing weight despite having a good appetite, an increased appetite, blurry vision, fatigue. Those things can happen for weeks or days at a time. They can be prolonged, especially in adults, where this process is going on slower. Patients may have slow weight loss over many months, and it’s a diagnostic mystery until someone looks for type 1 diabetes. Being aware of those symptoms is important.

First, you diagnose diabetes. You do those tests. This more of a problem in adults, although I’m sure there are difficult diagnostic situations in pediatrics as well, where you’re trying to figure out what type of diabetes is this. We see that all the time. Trying to differentiate between type 1 and type 2…is difficult at times. Tests you can use to help do that are the C-peptide, which is going to measure endogenous insulin production, so you can get an idea how much insulin is being produced by the beta cells. You want to get a concurrent blood glucose value so you can interpret that C-peptide; that’s missed a lot. There are these autoantibodies that we’ve been dancing around a bit. There are a number of them that you can order, and there are different strategies. Do you want to start with 1 and then, if that 1 comes back, order another 1 and decide from there. One approach is that we’re talking more and understanding that if you order a panel of these antibodies that are autoantibodies against the islet cells and they’re antigens, then we can narrow in on whether this is type 1 diabetes. There’s no test that’s 100% sensitive and 100% specific, but those antibodies are pretty close.

Steve Edelman, MD: Let me ask the 2 pediatricians here the same question. What are the clinical symptoms that might alert you to type 1 diabetes. Linda, go for it.

Linda A. DiMeglio, MD: Shaffer did a great job. Listening to your list of symptoms, yeast infection is something children and adults can present with; blurry vision is a more subtle sign. I often say to pediatric endocrinologists: teens are good at hiding symptoms, so you have to inquire. I had 1 child, and by the time she was diagnosed, every kid in her junior high was carrying a water bottle around because she was hiding those symptoms for a while. I don’t know if there are others that you can think of.

Steve Edelman, MD: What about bedwetting?

Egils K. Bogdanovics, MD: I have 3 kids. They all remember that every time they wet their bed, a finger stick [glucose test] was done.

Steve Edelman, MD: While they were sleeping.

Justin M. Gregory, MD, MSC: Start running because Dad is going to check my glucose. Those are symptoms we encounter. Interestingly, patients often lose a significant amount of weight and don’t realize it because you’re looking at yourself in the mirror every day. If it’s your loved 1, you see them every day. When they come into clinic, they’re shocked that they lost 5% to 10% of their body weight over a short time. I always find that interesting.

Steve Edelman, MD: Of course, how fast they present makes a big difference on their presentation.

Transcript edited for clarity