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 type 1 diabetes (T1D), most men still go unscreened due to infrequent clinic visits.1,2

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.2

“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 HCPLive 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.3

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 type 2 diabetes (T2D), 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.3

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.3

“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.

References

1. 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. https://doi.org/10.2337/dc25-S002

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

3. 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. doi:10.1111/dom.16402