When to screen a child for type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune disease that can develop at any age. Early screening can help kids and families know if they are at risk, monitor for warning signs and prevent serious complications like diabetic ketoacidosis (DKA).

“Although we don’t yet have a cure for diabetes, we do have the tools to manage it well,” says Abha Choudhary, M.D., Pediatric Endocrinologist at Children’s Health℠ and Associate Professor at UT Southwestern. “Screening programs, when combined with long-term follow-up, can drastically improve outcomes.”

What is diabetes?

Diabetes is an autoimmune disease in which the immune system mistakenly attacks the cells in the pancreas that make insulin – the hormone that helps control blood sugar.

There are two types of diabetes:

1. Type 1: With T1D, the immune system mistakenly attacks the pancreas as if it were a foreign organ.. Eventually, the pancreas can no longer produce insulin on its own. As a result, blood sugar levels become too high. This means people with T1D need to take insulin for their lifetime.

2. Type 2: With this form of diabetes, the body can produce some insulin but might not make enough of it or may not use it correctly. Healthy lifestyle changes, medication or insulin injections are needed to keep blood sugar levels under control.

Type 1 diabetes risk factors

Scientists don't know exactly why people develop T1D or what triggers the start of the disease. We do know that the following factors increase a person's likelihood of developing T1D:

• Family history. Children who have family members with T1D are 15 times more likely to develop diabetes than the general population. Anyone with a close relative (parents, siblings, grandparents, cousins, etc.) who has T1D should be screened right away.

• Other autoimmune disorders. Having another autoimmune condition like celiac disease or a thyroid disorder such as Hashimoto’s, is linked to a higher chance of developing T1D.

Not everyone who has risk factors will develop T1D.

Screening kids for T1D

Thanks to recent advances in science, a simple blood test helps kids and families know if they are at risk for T1D.

This test looks for specific proteins called autoantibodies in the blood. Autoantibodies are evidence that the immune system has mistakenly been attacking healthy tissue as if it were a dangerous organ.

Research has revealed that if a person has two or more islet autoantibodies, they have a high likelihood of developing T1D. These autoantibodies are typically present in the blood years before symptoms show or blood sugar levels become abnormal.

Detecting the earliest stages of the disease allows care teams to closely monitor children and put a treatment plan in motion long before DKA or other complications might occur.

Doctors may also use an A1C test to check your child’s blood sugar.

Screening for T1D can feel stressful and cause worry for families. But early testing allows families and doctors to create a plan for monitoring and care according to each child’s individual needs.

“We see that parent anxiety is initially high but goes down over the first year following screening,” says Dr. Choudhary. “Stress levels typically decrease once a plan is in place and glucose monitoring makes DKA less of a looming threat.”

Read more: Learn how Children’s Health helped one family monitor and care for four children with T1D.

How to get screened for T1D

If your child has risk factors or you are worried about them developing T1D, be sure to see your doctor for routine checkups and ask about screening options. Most T1D screening programs start at 2 years of age, but infants as young as 6 months old can be tested.

Children’s Health now offers free T1D screening through TrialNet at Children’s Health clinics in both Plano and Dallas. Children and adults who have close family relatives with T1D may be eligible.

“Our team uses each individual’s test results to create a custom care plan that provides the medical, educational and mental health support families need to navigate life before and after a type 1 diabetes diagnosis,” says Dr. Choudhary.

If your child has risk factors but their test results show they don’t have autoantibodies, you should keep up with regular checkups and return for periodic screenings.

Benefits of screening kids for T1D

Preventing DKA

Early T1D symptoms are often mild or mimic other conditions. This means that kids and families may not realize that they have T1D. Without insulin treatments for T1D, sugar can build up in the bloodstream. This can lead to a life-threatening complication called diabetic ketoacidosis (DKA).

Knowing your child is at risk for T1D can help families and health care providers monitor for early warning signs of the disease and prevent DKA.

Early monitoring and care planning for diabetes

Knowing a child’s risk can help families make a care plan and watch for symptoms. Families can also make lifestyle changes to help maintain a child’s overall health, like:

• Eating a balanced diet. Include more nutrient-rich foods like lean meat and dairy, whole grains, fruits and vegetables in your family’s diet.

• Increasing activity. Exercise helps lower blood sugar levels and improves how the body uses insulin. Add more movement into your family’s day by spending time at a park, playing sports or even just by being more active at home. Experts recommend that children aged 6–19 be physically active for at least one hour daily.

• Reducing stress. Maintaining good mental health is as important as taking care of your physical wellbeing.

A new medicine to slow the development of T1D

The FDA recently approved a new medicine that can slow the development of T1D in children who test positive for antibodies but don’t yet have the disease. Data suggests that teplizumab may delay the onset of T1D in high-risk children and adults by 2 or more years.

“We’re very excited to be among the first health care centers in the nation to offer groundbreaking immunotherapy infusions to our T1D patients,” says Dr. Choudhary. “These therapies are already showing promising results in slowing the disease and give me great hope for the future of T1D treatment.”

Resources for kids with T1D

Children’s Health offers many programs designed to help families make lifestyle changes that can help children with T1D stay healthy.

• Get Up & Go: A variety of programs that encourage kids and their families to improve their food and exercise habits.

• Children’s Health Clinical Nutrition: As one of the largest pediatric nutrition teams in the region, the registered dietitians at Children’s Health offer expert help to families who have special dietary needs or goals.

Learn more

Schedule a consultation with a pediatrician to discuss your child's risk factors and get appropriate screening. Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality, compassionate care with evidence-based practice to meet your child's medical needs. Learn more and find a pediatrician.

About our endocrinology program

Children’s Health Endocrinology specializes in hormone-related conditions, including pediatric diabetes. Free TrialNet T1D risk screenings and follow-up care are available to families with known diabetes risk factors. Learn more and find an endocrinologist.