Optimizing Screening and Diagnosis of Type 1 Diabetes - Episode 3
An expert pediatric endocrinologist addresses awareness of family history of type 1 diabetes as well as differentiating within type 1 and type 2 disease.
Elaine M. Apperson, MD: Any time there’s a family member with type 1 diabetes, it’s a good idea for the provider and that patient to have a discussion about risk of type 1 diabetes. It doesn’t necessarily mean that that child should be watched like a hawk for any sign or symptom of elevated blood sugar. That can be exhausting for the family, and it’s probably a very low yield. One thing about getting a home glucose meter is that those meters can be very inaccurate. They have a margin of error of about 15%, and checking all the time can be very anxiety provoking. If a child’s blood sugar normally goes up to 125 mg/dL after a meal, or if they drink a slushy from a gas station and it goes up to 130 mg/dL, the family might panic if the meter reads 155 mg/dL. That’s not a position you want to place them in. That said, it could be important to talk about the relatively low risk to family members of getting type 1 diabetes if they have a relative with it. Bear in mind, if that child presents with increased urination, thirst, weight loss, and fatigue, that’s a good patient to screen with a urinalysis and a blood sugar test in the office. I don’t, however, feel strongly that that patient should be referred to an endocrinologist or have genetic screening right there and then. It’s an option that the parents can pursue on their own.
There’s an array of the degree to which families are knowledgeable about family history of diabetes. Given that 90% of the diabetes in this country is type 2 diabetes, families may mistake a family history of type 2 diabetes, especially if the patient with type 2 diabetes is on insulin. Families may mistake that for type 1 and say that a relative has type 1 just because that relative is on insulin. They may report that as a type 1 diagnosed patient as their relative. It can be enormously confusing for these families. That’s why this conversation with the primary provider may never take place. However, if a family comes to you with concrete knowledge of a relative—immediate family or extended family—with definite type 1 diabetes, it’s a great conversation to have. But our newly diagnosed patients are not necessarily aware that they may have a family history of type 1 diabetes. Or they may state that they have a family with type 1 diabetes, but for that family member might be obese, might have been diagnosed at 50 years old, and might take oral medications as well as insulin. With those clarifications, you might realize that there isn’t a family member with type 1 diabetes.
Transcript edited for clarity