Figure 2.

(A) Pathways for Screening, Monitoring and Treatment.^{11,14,18,21,29,31–36} (B) Glycemic Monitoring and Treatment Options.^{4,11,18,37–39}

Notes: (A) ^aPediatric patients initially screened between the ages of 2 to 6 years may benefit from additional screening at 10 years of age. ^bRisk factors include the age of the patient at the time of initial screening, family history, and the presence of autoimmunity. Identical twins are at higher risk of development of T1D than fraternal twins and may require more frequent monitoring. ^cExperts may recommend repeat screening in 6 months to 2 years, depending on the age of the patient at the time of initial screening, family history, and presence of autoimmunity. A twin (fraternal or identical) with one positive antibody should be screened annually due to increased risk with the presence of diabetes autoantibodies. ^dAt this time, rescreening is not recommended for adults with 1 positive autoantibody and no family history of disease; however, there are limited data, and guidance is currently lacking. Experts recommend that adults with one positive autoantibody and a positive family history of autoimmunity repeat screening every 3 to 5 years. (B) ^eBecause individuals can stay at Stage 1 for decades, HbA1c testing every 3–6 months, depending on age and other risk factors, with or without use of CGM or OGTT is reasonable for glycemic monitoring.^36,38 However, individuals at Stage 2 (dysglycemia) should be monitored every 3 months with HbA1c and intermittent CGM.

Abbreviations: BGM, blood glucose monitoring; CGM, continuous glucose monitoring; HbA1c, glycated hemoglobin; OGTT, oral glucose tolerance test.