Unveiling the Power of Early Type 1 Diabetes Detection: A Conversation with Shara Bialo, MD
In a recent interview with Pharmacy Times®, Shara Bialo, MD, shed light on the critical importance of early detection of Type 1 Diabetes (T1D) and the role of autoantibody screening in enhancing patient outcomes. As a senior medical director at Sanofi and a pediatric endocrinologist living with T1D, Bialo emphasizes the need to address the barriers that hinder the adoption of autoantibody screening among healthcare professionals (HCPs).
The Importance of Early Detection
Type 1 diabetes affects approximately 64,000 people annually, with a significant number of cases occurring in adults. Early detection is crucial as it can prevent diabetic ketoacidosis (DKA), a life-threatening condition where the body burns ketones for energy due to the inability to use glucose. Bialo highlights that screening can almost completely eliminate DKA at onset, providing a substantial benefit to patients.
Moreover, early detection offers the gift of time. Many T1D patients are diagnosed in a crisis, such as DKA, which can be a traumatic entry point to living with a chronic illness. By catching the disease early, patients and families can prepare clinically and psychologically for insulin therapy, allowing them to navigate the challenges of T1D at their own pace.
Overcoming Barriers to Autoantibody Screening
Despite growing awareness, autoantibody screening is not yet standard practice. Bialo identifies several barriers that prevent broader adoption among HCPs. Firstly, clinician awareness is a significant challenge. Many HCPs may not be familiar with the three stages of T1D, the process of autoantibody screening, or the interpretation of test results. Additionally, questions about cost and reimbursement, as well as logistical and workflow constraints within daily clinical care, contribute to the reluctance to adopt screening practices.
Bialo also addresses concerns about patient anxiety. Some HCPs worry that uncovering asymptomatic conditions might cause more harm than good. However, research shows that patients psychologically fare better in the long term when they have time to prepare and aren't suddenly thrown into a crisis. The recent development of consensus guidance on managing patients with autoantibody positivity has provided clarity on monitoring these patients.
The Role of Pharmacists in Screening Conversations
Pharmacists play a valuable role in reinforcing screening conversations and educating families about T1D risk and prevention. Bialo suggests that pharmacists, who often interact more frequently with patients and families than endocrinologists or primary care physicians, can identify potential candidates for screening based on family history, symptoms, and medications. By providing education about the increased risk of T1D in family members with a history of the disease, pharmacists can empower patients and families to take the next step in screening their loved ones.
Repetition of messaging is key to driving action. When patients hear about T1D screening from their pharmacists and then again from other healthcare providers, it reinforces the importance of the topic and demonstrates cohesive messaging from the entire medical team.
Moving Towards General Population Screening
Bialo emphasizes the need to move towards general population screening, as 90% of people with new-onset T1D have no family history of the disease. While progress has been made, there are still many steps to reach this goal. Diabetes-specific societies, such as the American Diabetes Association, provide guidance on offering screening to high-risk individuals, including those with a family history of T1D or autoimmune diseases.
In conclusion, early detection of Type 1 Diabetes through autoantibody screening is a powerful tool to improve patient outcomes. By addressing the barriers to adoption and leveraging the expertise of pharmacists, healthcare professionals can work together to catch T1D early, prevent DKA, and give patients and families the time they need to prepare for insulin therapy.
