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.
Clinicians that see patients at-risk for T1D, including primary care clinicians, pediatricians, endocrinologists, pediatric endocrinologists, and other members of the healthcare team, are on the front lines of the new paradigm in T1D: the ability to slow disease progression. However, it does require that high-risk patients—possibly all patients—be screened for autoantibodies to the disease.2
Screening should include:
Stage patients based on the American Diabetes Association’s staging guidelines, plus the patient’s autoantibody results and glucose levels.
Inform at-risk patients of available treatments to slow diabetes progression, the need for continuous monitoring, the clinical signs of T1D, and the availability of clinical trials.
Discuss the possibility of initiating teplizumab in eligible stage 2 T1D patients, or refer the patient to appropriate specialty care.
