Special Report: Why earlier T1D diagnosis matters for long-term outcomes

In the third episode of the Special Report: Advances in Type 1 Diabetes Management, Contemporary Pediatrics examined how recognizing type 1 diabetes as a staged autoimmune disease changed both the timing and goals of diagnosis. Moderated by Herbert Bravo, MD, the discussion focused on the scientific rationale for early screening and why identifying disease before clinical onset carried meaningful benefits for children and families.

Bravo referenced work led by Marian Rewers, MD, PhD, noting that type 1 diabetes could now be diagnosed months to years before insulin was required. He highlighted evidence showing that islet autoantibodies often peaked between 9 and 18 months of age, making early childhood a critical window for detection in the pediatrician’s office. Rewers confirmed this understanding, while emphasizing that screening only made sense when it produced clear benefits for individuals and for society.

The conversation then turned to the 3-stage classification of autoimmune diabetes. Bravo summarized the model, beginning with autoimmunity and normal glycemia, progressing to dysglycemia with multiple autoantibodies, and culminating in overt hyperglycemia requiring exogenous insulin. Rewers explained that defining disease progression in this way allowed clinicians to intervene earlier and, most importantly, prevent diabetic ketoacidosis at presentation.

Rewers described diabetic ketoacidosis as a life-threatening condition with lasting consequences. He noted that in Colorado, a child died from DKA approximately every 2 years, often due to delayed diagnosis. Beyond acute mortality, he explained that DKA was associated with brain edema, kidney injury, and damage to pancreatic beta cells. Studies comparing children diagnosed with and without DKA demonstrated differences in long-term glycemic control, with higher hemoglobin A1c levels persisting for up to 15 years in those who presented with severe DKA.

While Rewers cautioned that some downstream benefits, such as reductions in retinopathy or kidney disease, had not yet been definitively proven through screening studies, he emphasized that preserving beta-cell function and preventing metabolic crisis were clear and immediate advantages. Together, the experts reinforced that delayed diagnosis of type 1 diabetes carried substantial neurologic and metabolic risks, strengthening the case for earlier identification.

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.