Early Intervention by Family Physicians to Delay Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune disease mediated by T cells that target and destroy insulin-producing beta cells. Individuals with genetic risk of T1D will progress at variable rates through 3 stages of immune activation and development of islet autoimmunity. Measuring pancreatic islet cell autoantibodies predicts risk for progression that can take weeks to years before the onset of T1D. Screening options available to family physicians can identify persons at risk or in the early stages of T1D, such as first- and second-degree relatives or those with a family history of autoimmune disorders, to ultimately offer proven interventions that may delay or prevent the condition. Screening can reduce emergency room visits, hospitalizations, and intensive care unit admissions for diabetic ketoacidosis, which can be fatal, and can educate and prepare individuals and families for a smoother transition to insulin therapy when necessary. Recent advances in technology and understanding of the immune pathogenesis of T1D has resulted in emerging disease-modifying therapies that are changing how family physicians approach delaying and potentially preventing or reversing the disease.