Autoimmune diabetes and preventing diabetic ketoacidosis

Herbert Bravo, MD, a pediatrician, co-founder, and co-host of The Pediatric Lounge podcast, emphasized the importance of early screening for autoimmune diabetes to prevent diabetic ketoacidosis (DKA) and its long-term complications.

Bravo highlighted a shift in understanding type 1 diabetes, stating, “We used to think of type 1 diabetes as juvenile onset diabetes. Now, we know that 60% of the cases are diagnosed in adults, and about 40% of type 2 diabetics are misdiagnosed—they’re actually autoimmune diabetics.” He also noted advancements in the classification of autoimmune diabetes stages.

“In 2014, the American Diabetes Association defined autoimmune diabetes, or type 1 diabetes, as having 3 distinct stages. Stage 1, you still are euglycemic, so you would not be able to tell by glucose, hemoglobin A1C, or an oral glucose test. In stage 2, you are dysglycemic, so we can already tell your glucose metabolism is being affected, and in stage 3, you are now insulin dependent for life.” He added that a proposed stage 4 represents the chronic state of the disease where insulin production is entirely absent.

Bravo called for incorporating autoantibody screening into routine pediatric care, explaining, “This process is very simple, because you can attach it to somewhere between 2 years or 4 years of age. You want to screen at least twice. So you could think of it at buckets—the autoantibodies peak at about 18 months. So if you were screening anybody at 18 months or 2 years of age, first, that coincides with routine blood work that is obtained already in the pediatric office.”

Bravo concluded by emphasizing the high stakes of delayed diagnosis.

“If you don’t diagnose early, up to 80% of the kids will end up with DKA presentation, which leads to very, very acute complications, sometimes including death, but decreased IQ, learning disabilities, and a long-term damage of the pancreas.”

He underscored that early detection is cost-effective, easy to implement, and has the potential to significantly improve outcomes for children at risk.