Applying the Latest Evidence to Delay the Onset of Type 1 Diabetes - Episode 3
Expert healthcare practitioners discuss the potential of CGM and other technology to identify signs of type 1 diabetes.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: There's starting to be a lot of efforts to screen people with TrialNet. I'm curious your thoughts. Once someone has those autoantibodies, I know in the trial a glucose tolerance test was done. What do you think about maybe using CGM [continuous glucose monitoring] to identify that stage 2 versus doing a glucose tolerance test?
Emily Sims, MD: There's some great data out of the Barbara Davis Center that CGM metrics can be helpful to identify people who are high risk of screening. The only issues with CGM are it's dependent on what people eat, is one issue. It's less standardized than the oral glucose tolerance test. It seems like the data can be variable. They can be more variable than with the OGTT data. It's something that's appealing and as we're thinking about rolling screening out to more and more people in the population, we're going to have to be more flexible about the things that are going to work for different people and how to identify different people because at the end of the day, the more people that are getting monitoring, maybe it's not the kind of gold standard perfect monitoring but if it can be applied to more people, that's the thing that's the most important. We're going to be thinking a lot more about maybe glucose tolerance tests aren't going to work for you but what are the other things that we know can give us good information that might be useful? Maybe even hemoglobin A1C screening for some people too because it's just one finger stick even though it's maybe not quite as sensitive as that oral glucose tolerance test. Maybe if someone has in their hemoglobin A1C, it could give you a lot of information.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: That's a good point. That would be a lot easier, a lot more convenient to do.
Natalie Bellini, DNP, FNP-BC: Maybe in the beginning what you do is you put a sensor on the patient and say, look at these spikes. Now we need to do an official test because it's part of the FDA approval. Even for the finger stick, we've had families who have called and said, we think our son has Type 1. I'm like, well, go give him some pancakes and syrup and check his blood sugar and call me back. That same idea is, are you seeing the spike or not? Then we can put you into this protocol.
Emily Sims, MD: Give more official testing. I agree.
Natalie Bellini, DNP, FNP-BC: That's a big part of it too.
Emily Sims, MD: It's going to be interesting, these next steps now that we have something to intervene. We need to be talking about ways to identify more and more people that are going to benefit because depending on where you live, a lot of the screening that's available is only to family members. Hopefully, more and more general population screening is going to become available. Another big need monitoring guidelines for these people who we know are at risk, who are antibody positive because there's different things out there, but I think it would be nice to have clear guidance, especially for family practitioners and primary care providers who are going to be seeing these patients a lot and need to have a plan for what to do with them.
Natalie Bellini, DNP, FNP-BC: As a person who practices endocrinology, these aren't my patients yet. They're going to be if they're positive but they're not yet. How do I get the pediatrician, the primary care, the family practice groups to screen for these so that the patient is identified as quickly as possible and we really can move forward?
Emily Sims, MD: There's a big need for education now because a lot of people aren't familiar with the idea of stages of diabetes but kind of clear guidelines for monitoring. It's a no-brainer for people who are family members in the United States because they can get screened for free through TrialNet but if it's someone who doesn't have a family history, then it's more complicated. There are some states that have screening programs that are available and then JDRF has a link on their website to screening that people can pay for or do through insurance but some of the kinks need to be ironed out of that.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: A lot of people that get Type 1 diabetes, don't even have a family history so it's kind of like, well, who should be screened? Anyone with any type of autoimmune disorder in their family. There's a lot of questions.
Emily Sims, MD: There's been some talk about potentially including genetic screening for high genetic risk for Type 1 diabetes on the newborn screen. Then people who would be really high risk then could get followed up over time with autoantibodies. It's very interesting. That would be a big paradigm shift on the newborn screen. It's not diagnosing something; it's just diagnosing a high genetic risk for something. There's many, many logistics that need to go into place, but I think, potentially really, exciting and opportunities to intervene early in disease and change that kind of natural trajectory for a lot of people.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: Well, thank you so much for sharing all your knowledge and wisdom with us. We really enjoyed talking with you today and having you here.
Emily Sims, MD: No problem. This was fun, you guys. Thanks for inviting me. I appreciate it.
Transcript Edited for Clarity