Patient Support Strategies and Practice Implications

Managing type 1 diabetes (T1D) requires a multidisciplinary approach with the appropriate referrals to specialists, including nephrologists, optometrists and ophthalmologists, cardiologists, podiatrists, and endocrinologists to monitor patients for diabetes-related complications.

The pediatrician may be the primary physician seen in children, typically with support from a pediatric endocrinologist. Adults may be followed by their primary care physician, again with support from an endocrinologist.

Certified diabetes educators provide personalized education and support for diabetes self-management. Registered dietitians are important for appropriate nutritional support. Pharmacists are helpful for medication education and management.¹

For patients receiving infusible immunotherapy, add the infusion nurse to the team.

However, this same multidisciplinary approach needs to be used even before patients develop stage 3 T1D, beginning in the screening stage. Successfully implementing screening and monitoring relies on establishing partnerships between primary care providers, endocrinologists, diabetes educators, mental health professionals, and specialists to address both the medical and psychosocial needs of affected individuals and their families.²

Primary care physicians play a crucial frontline role in initial screening and routine monitoring, but they need to work in close collaboration with diabetes specialists who can provide expertise for more complex aspects of care. In an ideal world, primary care clinicians with a specific interest in managing early-stage T1D would serve as a local referral resource when specialist care is not accessible^2,3

The psychosocial impact of an early-stage T1D diagnosis requires routine involvement of mental health professionals given the significant anxiety, depression, and stress individuals and their family members experience. Ideally, these mental health professionals would have specific diabetes expertise so they can provide ongoing assessment and support to help families cope with the uncertainty of disease progression.

Current guidance strongly recommends integrating psychological care into routine medical visits to help normalize mental health support as a standard component of care while improving access and reducing stigma.²

Diabetes educators are crucial for delivering comprehensive education about monitoring protocols, recognizing symptoms, and preventing complications such as diabetic ketoacidosis.

Laboratory medicine specialists and clinical research teams are also vital members of the care team, particularly for confirming autoantibody status and conducting metabolic monitoring.

When patients progress to stage 2 disease, additional specialists may need to join the care team to evaluate eligibility for clinical trials or disease-modifying therapies. This requires coordination between research teams, clinical providers, and specialists in immunotherapy administration and monitoring.²

Also include school nurses and administrators for pediatric patients to ensure appropriate monitoring and emergency response protocols in the educational setting. Similarly, for pregnant women with islet autoantibody positivity, coordination between diabetes specialists and maternal-fetal medicine experts is essential.

Critical to making this multidisciplinary approach work is clear communication channels and defined roles among team members. Regular case conferences and shared care protocols can help ensure alignment, while electronic health records and other digital tools can facilitate information sharing across the care team.