What's Next? Educate, Support and Refer

What's Next? Educate, Support & Refer

In this section, we will discuss next steps for an individual who has tested positive for antibodies known to cause T1D. This includes addressing their emotional mindset, establishing a glucose monitoring protocol, and educating them on the lifestyle and medical options for delaying and easing the transition to T1D.

Addressing emotional mindset

A positive antibody screening can trigger several emotional reactions in the affected individual and their family. In most cases, there is already familiarity with "life with T1D" because a family member lives with it. You can help them by conveying a positive and empowering approach. Provide reassurance that T1D is not caused by anyone in the family or due to choices made by the individual. Make it clear that the result was determined by a genetic variant.

Monitoring protocol

Guidance for monitoring persons with islet autoantibody-positive pre-stage 3 T1D is currently in development. However, it is important to note the benefits of tracking glucose levels, so diagnosis and insulin treatment can be started as early as possible.

Consider the following monitoring protocol. Keep in mind that most individuals affected will already have access to monitoring supplies through an immediate family member:

• Fingerstick blood glucose checks at least once weekly in a fasting state, and once weekly 1 to 2 hours post-meal.
• Continuous glucose monitor use for one sensor cycle (typically 7-14 days) per month.
• A1C measurement every three months.

Instruct individuals and their families to immediately report any of the following so a potential diagnosis can be determined:

• Fasting glucose >100 mg/dl
• Postprandial glucose >200 mg/dl
• A1C >5.7%
• 10% rise in A1C on consecutive measurements

Health Behavior Interventions

Health behavior choices can have a major impact on beta cell health and the progression from early to later stages of T1D.

PHYSICAL ACTIVITY

Accelerometry data from young children has shown an 8% decrease in progression from Stage 2 to Stage 3 T1D for every 10-minute increase in daily physical activity.

In adults, the honeymoon phase of T1D was found to be more than five times longer in active than sedentary individuals. This may be due to enhanced beta cell endoplasmic reticulum health in individuals who perform regular aerobic or anaerobic exercise.

WEIGHT MANAGEMENT

Body mass index is an independent risk factor for T1D, particularly during adolescence and early adulthood. Counsel individuals with overweight or higher BMI who are at high risk of developing T1D on age-appropriate weight-loss strategies.

Vitamin D plays a key role in health, immune system development, and function. Deficient levels of vitamin D have also been associated with impaired insulin release by pancreatic beta cells. Supplementation has been shown to delay the progression of T1D in children and adolescents and may also benefit adults — particularly those who are vitamin D deficient.

Enterovirus, along with other similar strains, is strongly associated with islet autoimmunity and progression to T1D. Reducing the incidence and severity of viral infections can be effective for preventing or delaying the autoimmune response that causes T1D.

Individuals at high risk for developing T1D should be educated on proven virus prevention strategies:

• Personal hygiene (hand washing, masking, avoidance of crowds and ill individuals)
• Food safety practices
• Full vaccinations
• Travel precautions
• Avoidance of animal and insect bites

Medical interventions

Medications that blunt immune system activity or enhance beta cell health may help delay the development of T1D in high-risk individuals. Some medications have been studied within randomized clinical trials, while others that are indicated for unrelated health conditions have been observed to offer potential benefit to those with early-stage T1D.

Insulin sensitization

Reducing insulin requirements and beta cell stress may help delay the progression of T1D. Interestingly, many of the strategies applied to improve insulin sensitivity are also used to treat Type 2 diabetes.

Health behavior strategies include:

• Meal planning, with reduced carbohydrate intake and selection of low-glycemic-index foods (Note: low carbohydrate diets are not advisable in pediatrics.)
• Consumption of antioxidant-rich foods and supplements
• Stress-management strategies
• Optimization of sleep quantity and quality

Medical approaches may include:

• Taking medications known as insulin sensitizers
• Avoiding steroid medications (when alternative options are available)

Key Takeaways

For those who test positive for T1D-inducing autoantibodies:

• Offer emotional support by expressing empathy and listening to clients’ concerns. When emotional issues persist or interfere with the ability to function, refer for appropriate mental health counseling.
• Instill a sense of empowerment, not victimization!
• Establish a schedule for glucose self-monitoring and reporting.
• Educate on health behavior strategies that increase insulin sensitivity.
• Refer to medical and mental health specialists as needed.
• Apply techniques to enhance insulin sensitivity and reduce beta-cell stress.

Addressing the emotional mindset and psychosocial implications and support needed by individuals will be discussed in the next section.