Special Report: Implementing screening and type 1 diabetes education across care continuum

In episode 6 of the Special Report: Advances in Type 1 Diabetes Management, Contemporary Pediatrics focused on the practical challenges of implementing early detection and disease-modifying strategies for type 1 diabetes across the health care system. Moderated by Herbert Bravo, MD, the discussion addressed gaps in clinician education, workflow barriers, and the need for coordinated care beyond the pediatrician’s office.

Bravo raised concern that many general pediatricians still associated type 1 diabetes exclusively with insulin-dependent crisis, rather than with earlier autoimmune stages. He emphasized that successful implementation of emerging therapies required education not only for pediatricians, but also for emergency medicine physicians, hospitalists, and intensive care teams. Delays in autoantibody testing and limited familiarity with screening protocols, he noted, risked undermining opportunities for timely intervention.

Marian Rewers, MD, PhD, clarified that speed of autoantibody turnaround was less critical in asymptomatic children seen in primary care. For children with concerning symptoms such as weight loss, polyuria, or polydipsia, he stressed that clinicians should first rule out active diabetes using rapid tests such as hemoglobin A1c or random blood glucose rather than waiting for antibody results. Autoantibody testing, he explained, functioned best as part of a broader public health screening strategy. Children with multiple islet autoantibodies faced a very high likelihood of progression, with long-term data showing that approximately 85% developed clinical diabetes by age 15.

The discussion then turned to implementation of immunotherapy for patients with newly diagnosed stage 3 disease. Bravo noted that earlier administration of therapy appeared more beneficial, raising questions about how quickly patients could be identified and referred. Rewers explained that endocrinology-led pathways were essential, with rapid transitions from diagnosis to education, insulin initiation, and referral to infusion centers. While larger academic centers were better positioned to do this efficiently, he emphasized that smaller practices could still participate with appropriate referral networks.

Our experts

Herbert Bravo, MD, is a pediatrician and the president and founder of the Society for Innovation in Pediatrics. He is also the co-founder of The Pediatric Lounge Podcast.

Marian Rewers, MD, PhD, is a professor of Pediatrics and Medicine at the University of Colorado School of Medicine and executive director of the Barbara Davis Center for Diabetes.

Editor's note:

Herbert Bravo, MD, reports disclosures for Society For Innovation in Pediatrics, Sanofi, and Barbara Davis Center.