Early Diagnosis of T1D


Linda A. DiMeglio, MD, comments on the importance of early diagnosis of T1D, giving patients the advantage of preparing a treatment plan early.

Steve Edelman, MD: Why is the early diagnosis of type 1 diabetes so important? It’s in the title of this program. What are the major consequences of underdiagnosed type 1 diabetes on not only the individual but also the family?

Linda A. DiMeglio, MD: It’s an important question, and I look forward to hearing everybody’s perspectives. Early diagnosis is important for several reasons. One is being able to potentially prepare for the diagnosis of diabetes in somebody who’s at risk. Although it’s an impactful and difficult diagnosis to identify somebody, particularly stage II but also stage I, it’s a chance for family members and an individual who’s going to be living with diabetes to adapt, get prepared, and come up with a plan for starting insulin. For individuals who aren’t diagnosed early and are diagnosed later with symptomatic diabetes, 40% to 60% of those individuals will be diagnosed with DKA [diabetic ketoacidosis]. That’s difficult at the time, but it also has long-term metabolic consequences for individuals. We’ve been able to document that individuals who had DKA diagnosis have more issues with hypoglycemia and hyperglycemia over time. I used to think that was because they were identified later in the course of diabetes, but there’s that metabolic memory around having had DKA. For our children, there are neurocognitive complications related to the DKA.

Steve Edelman, MD: Except for us 3.

Linda A. DiMeglio, MD: Your cognition is amazing.

Steve Edelman, MD: Despite it all. That’s interesting, this whole metabolic memory. We even differentiate mild and severe DKA with elevated A1C [glycated hemoglobin] later. There are many things we don’t know. Schafer, were you going to say anything on that?

Schafer Boeder, MD: As adult endocrinologists, we don’t experience that quite as much. But patients come in with DKA, and that’s their initial presentation. I also work on the inpatient side as a diabetes doctor. I see a lot of DKA. We occasionally forget that it’s not a benign occurrence. Survival rates are quite good, although you can die from DKA. It’s very dangerous to have, and it’s not good for the body, metabolism, or organs. It’s something to be avoided if we can.

Linda A. DiMeglio, MD: I want to add 1 thing that’s important around early diagnosis: if we can identify patients early, we can also get them into trials and learn more about the development of diabetes. At any given time, there are always open research studies looking at patients with presymptomatic type 1 diabetes. So, it’s also important to consider the benefits of knowing prior to symptomatic disease.

Egils K. Bogdanovics, MD: You probably see in your practice that when a family has 1 individual with type 1 diabetes, the second 1 is diagnosed much earlier.

Linda A. DiMeglio, MD: Usually, yes.

Egils K. Bogdanovics, MD: Not in DKA.

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