T1D Screening is Effective but Underused Among Patients With No Disease History, With Shara Bialo, MD

Type 1 diabetes (T1D) screening can effectively predict the disease before the first symptoms appear; however, despite its efficacy, many patients are not offered screening and are only diagnosed after the first symptoms have appeared.1

T1D is an inherited disease, and often a family history is the primary impetus for investigation and diagnosis. Relatives of patients with T1D have a roughly 15-fold greater risk of disease compared to those without a relative with T1D. However, roughly 90% of all patients who will present with new T1D do not have a positive family history.1

“T1D gets a lot of attention for its metabolic consequences, but we’re starting to shift the focus a bit earlier to its true autoimmune roots, which is this underlying, silent disease evolution that doesn’t really call our attention until it’s clinically obvious,” Shara Bialo, MD, senior medical director of T1D immunology at Sanofi, told HCPLive in an exclusive interview. “However, it turns out that you can detect it months to years before clinical signs and symptoms emerge – and you do that through screening for T1D.”

T1D screening is typically conducted via a blood test, which is then investigated for autoantibodies created by the immune system to destroy insulin-producing cells. The presence of ≥2 diabetes-related antibodies warrants a diagnosis, although clinicians frequently corroborate this data by examining blood sugar levels.2

Among the positive impacts of screening for T1D is the avoidance of diabetic ketoacidosis (DKA), a devastating and potentially life-threatening complication affecting longevity, morbidity, and quality of life. Previous trials have highlighted the efficacy of various methods of reducing the rate of DKA; among these, T1D screening and follow-up reduced the rate of DKA by 20%.1

Low utilization of T1D screening is not due to limited access or high cost – most methods are free. Only a small number of patients are aware of the opportunity to predict T1D. Many clinicians have long been pushing for general population screening for T1D, which would help prevent major conditions such as DKA. However, logistical challenges, such as working with primary care physicians and optimizing cost-effectiveness, still prevent screening from being generalized to the full population.1

Bialo discusses how patient awareness can be improved, suggesting that healthcare providers and clinicians emphasize the value of predicting and potentially forestalling the disease.

“Brief conversations can really make a meaningful difference for patients and their families, and it could start with simply knowing that screening exists,” Bialo said. “It’s okay for it to be a slow rollout, but over time, we should make our way to general population screening. We’ve been missing the vast majority of individuals who could be helped because we’ve kept our area of focus too narrow, but there’s definitely a chance to start somewhere.”

Editors’ Note: Bialo reports no relevant disclosures.

References

1. Sims EK, Besser REJ, Dayan C, et al. Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective. Diabetes. 2022;71(4):610-623. doi:10.2337/dbi20-0054

2. Centers for Disease Control and Prevention. Screening for type 1 diabetes. Centers for Disease Control and Prevention. February 23, 2026. Accessed March 12, 2026. https://www.cdc.gov/diabetes/diabetes-testing/screening-type-1-diabetes.html#cdc_generic_section_3-how-screening-works