Detecting type 1 diabetes

Approximately one in 10 patients we see in the pharmacy are living with diabetes. This number climbs to three in 10 if we include those who are prediabetic.1 As of 2023, there are estimated to be an additional 1.7 million individuals who are living with diabetes but are undiagnosed. Point of care testing in community pharmacies around the country has played a significant role in finding these patients and supporting them with appropriate lifestyle and pharmacotherapy interventions. It is no secret that our healthcare system is designed for treatment-related interventions. Physicians have few, if any, billable codes that reimburse preventative measures. That being said, the emerging trend to help patients living with type 2 diabetes (T2D) achieve remission is gaining momentum. Remission is defined as maintaining an HbA1c below 6.5% without the use of any diabetes medications for at least 3 months. Recent studies have shown that significant weight loss, either through intensive lifestyle interventions or bariatric surgery, can lead to diabetes remission in many patients. Sticking with the intensive lifestyle changes is not easy and only motivated individuals find success. Patients need to adhere to low-energy formulas of just 850 kcal/day and time-restricted fasting for 16 hours per day for three months followed by structured food reintroduction for two to eights weeks. Since the vast majority of patients living with diabetes are type 2 in nature, much of the focus on proactive glucose management has been done for these patients. That being said, what is being done to proactively manage patients at risk of developing type 1 diabetes?Researchers have developed a blood test that can detect beta-cell autoantibodies, allowing early detection of T1D. This allows for timely intervention and prevention of complications such as diabetes ketoacidosis (DKA). Diabetes ketoacidosis is a critical complication and the leading cause of hospitalization in children with autoimmune T1D. It accounts for 70% of diabetes-related deaths in those under 10 years, often due to cerebral edema.2Who should get tested?Screening can begin at the age of two and should be started as early as possible. Patients eligible for screening include those with a family history of T1D or other autoimmune disease. The lifetime risk of developing T1D is increased approximately 15-fold in family members of individuals with T1D compared with the general population3; the prevalence of developing Stage 3 T1D by age 20 is significantly higher (~5%) in those with a first-degree relative with diabetes than in the general population (~0.3%)4.How to get tested?Screening options are available through blood requisitions from primary care physicians or accessing research services such as TrialNet. TrialNet is an international network of leading academic institutions, endocrinologists, physicians, scientists and healthcare teams at the forefront of T1D research.5 They offer risk screening for relatives of people with T1D and innovative clinical studies testing ways to slow down and prevent disease progression. For more information or to request a screening kit, they can be contacted here. What to do with the results?If the test finds zero autoantibodies, patients should speak with their physician about rescreening every year until the age of 18 if other family members receive a T1D diagnosis. If a positive screening result is obtained, further consultation with an expert in early T1D should be considered. Testing positively for one autoantibody means patients are at an increased risk for developing T1D. Patients should be advised to get tested for all five autoantibodies and rescreening should be done annually. If the test finds two or more autoantibodies, this is a sign that the earliest stages of T1D have begun and options should be discussed with their healthcare team. Earlier this year, Sanofi announced a new partnership with Breakthrough T1D (formerly known as JDRF Canada) aims to raise awareness about T1D and its critical role in screening and its early detection (before symptom onset and the need for exogenous insulin). This is essential to preserve beta cell function, prepare for disease progression, and apply evidence-based guidance for the monitoring and management of individuals at risk of developing T1D.6Action stepsEncourage you, or any of your patients living with T1D to have their children screened for T1D through contacting Trialnet.Share this newsletter with your pharmacy team. Helping your patients through this emerging screening tool can change their lives, and help build loyalty and strengthen your relationships in your community. This helps you make a difference and indirectly improves your job satisfaction.Manjit Hansra is a consultant Pharmacist, Certified Diabetes Educator, and founder of Rx for Renewal. He works as a clinical pharmacist helping patients using CGM technology get to target through the use of cloud-based diabetes applications. Subscribe to his weekly newsletter HERE.References:Diabetes in Canada. Estimated Prevalence and Cost of Diabetes. Diabetes Canada.Bonadio W. The evaluation and management of pediatric diabetic ketoacidosis: A comprehensive review. Clinical Pediatrics. 2024; 62 (6):551-564.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/dbi20-0054Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37(7):2034–2054. doi:10.2337/dc14-1140What is TrialNet? JDRF Canada: Juvenile Diabetes Research FoundationMoore DJ, Leibel NI, Polonsky W, Rodriguez H. Recommendations for Screening and Monitoring the Stages of Type 1 Diabetes in the Immune Therapy Era. International Journal of General Medicine 2024: 17 3003-3014.

Detecting type 1 diabetes

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