Screening for diabetes in primary care and CGM, AID advice for providers

In this Contemporary Pediatrics video interview, Greg Forlenza, MD, a pediatric endocrinologist at the Barbara Davis Center for Diabetes at the University of Colorado, joined us to discuss screening in primary care for type 1 diabetes, as well as some practical clinical pearls for navigating continuous glucose monitors (GCM) and automated insulin delivery (AID) systems.

“Five or 6 years ago, testing type 1 diabetes antibodies was very expensive, very difficult to do. Only a handful of centers would do it, and you couldn’t generally get it covered," said Forlenza. "Within the last, really, 3 or 4 years, it’s moved to a lot of commercial labs are doing standard type 1 diabetes antibody panels, and the antibodies are inexpensive and reliable.”

Forlenza highlighted that advancements in screening have enabled earlier detection of diabetes stages, allowing for more proactive care. “We’re having patients that are detected at earlier stages of diabetes—stage 1, which is antibody positive, you know, asymptomatic. Stage 2, antibody positive, mild glycemic abnormalities. Stage 3 is the stage where people are familiar with that’s symptomatic. And so we’re seeing more and more people identified at that stage.”

Technology also continues to revolutionize diabetes care. “We’ve moved in the last 5 years from CGM being a later tool to now it being a diagnostic tool, and that’s really where we want to see patients go,” Forlenza said.

“We [now] have families where the kids do 1 finger stick every week, rather than 10 finger sticks a day, and they don’t even realize how good that is compared to where we were when I started doing this.”

Forlenza emphasized the importance of adopting a technology-first approach.

“We’re recommending CGM for everyone with diabetes as early as possible, and AID for everyone with type 1 diabetes, again, as early as possible. It’s not something you have to earn. It’s not something you have to be doing well enough to get. It is the tool that facilitates [the patient] doing well.”

To pediatricians and primary care providers, Forlenza advised starting conversations about technology early.

“I would encourage primary care providers to say to the families, ask questions about technology early and talk to your provider about it early so you can start learning about it early and get on it as quickly as possible.”

Early engagement reduces barriers and ensures that every child with type 1 diabetes receives the tools necessary to succeed.

In a previous interview, Forlenza highlighted the rapid pace at which technology in the type 1 diabetes and endocrinology field moves. Click here to watch.