Special Report: Rethinking type 1 diabetes through a screening lense

In the second episode of the Special Report: Advancing Type 1 Diabetes, Contemporary Pediatrics continued a peer-to-peer discussion focused on how redefining type 1 diabetes as a staged autoimmune disease has shifted both scientific understanding and clinical practice. Moderated by Herbert Bravo, MD, the conversation examined how the 3-stage classification model challenged long-held assumptions and raised new questions about prevention and early detection in pediatric care.

Bravo framed the discussion by asking how the evolving science of type 1 diabetes translated into the realities of the exam room. Marian Rewers, MD, PhD, responded by placing the issue within the broader context of preventive medicine. He compared the current state of type 1 diabetes screening to the early development of newborn screening programs, which now routinely test for 20 to 35 metabolic and endocrine conditions. Rewers noted that despite widespread acceptance of newborn screening, childhood preventive care rarely includes blood-based testing beyond infancy.

Rewers highlighted what he described as a major gap in pediatric preventive medicine. While clinicians routinely screen for hearing, vision, and developmental concerns, few blood tests are performed across the subsequent 18 years of childhood. He emphasized that many serious and prevalent conditions can only be detected early through blood testing, yet logistical challenges and discomfort around blood draws remain barriers for families and clinicians alike.

The discussion also addressed how misconceptions about type 1 diabetes have shaped clinical thinking. Bravo acknowledged that until recently, he viewed type 1 diabetes primarily as a condition defined by the need for lifelong insulin therapy. Rewers explained a prolonged, asymptomatic autoimmune phase that precedes clinical onset. He likened this shift in thinking to established screening practices in adult medicine, such as mammography for breast cancer or lipid screening for cardiovascular disease, where disease is identified long before symptoms appear.

Together, the exchange underscored how the 3-stage model reframed type 1 diabetes as a condition that could be identified earlier and managed more proactively. By aligning type 1 diabetes with other screened chronic diseases, the discussion reinforced the rationale for expanding early detection strategies and integrating them into routine pediatric practice.

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.