Type 1 diabetes can now be detected and treated years before symptoms appear, thanks to a groundbreaking immunotherapy that has shifted how doctors approach the disease from managing insulin deficiency to treating it as an autoimmune condition. The FDA approval of teplizumab-mzwv (Tzield) in 2022, followed by expanded approvals for younger children and recently diagnosed adolescents, has created an unprecedented opportunity to intervene early, but experts say widespread screening and education are essential to make this approach work.

What Changed in Type 1 Diabetes Treatment?

For decades, type 1 diabetes was managed primarily as a metabolic disease requiring insulin replacement. The approval of teplizumab-mzwv marked a fundamental shift in thinking. This immunotherapy targets the autoimmune process itself, not just the symptoms. The FDA first approved it in 2022 to delay the onset of stage 3 type 1 diabetes, then expanded its use to children aged 1 to 7 years in April 2026, and most recently approved it for children and adolescents aged 8 to 17 years who were recently diagnosed with stage 3 type 1 diabetes.

"Type 1 diabetes is an autoimmune disease and not just an insulin deficiency disease. We're trying to treat it as such by screening for it early. That's one area we have as an advantage over other autoimmune diseases: We can intervene in the presymptomatic state," said Laura Jacobsen, MD, associate professor of pediatrics at University of Florida.

Laura Jacobsen, MD, Associate Professor of Pediatrics at University of Florida

This represents a major departure from traditional medicine, where doctors typically diagnose a disease after symptoms or complications appear, then begin treatment. Type 1 diabetes screening flips that model on its head: identify the disease in its earliest stages, monitor it closely, and treat it before patients experience any symptoms.

Why Is Early Screening So Important for Type 1 Diabetes?

The key to making this new approach work is identifying people at risk before their blood sugar becomes dangerously high. Doctors can now use autoantibody tests to detect the autoimmune attack on the pancreas years before symptoms develop. According to the American Diabetes Association 2026 Standards of Care, screening should be offered to people with a family history of type 1 diabetes or elevated genetic risk.

The stakes are particularly high for relatives of people with type 1 diabetes. Someone with a first-degree relative who has the disease carries a 15 times greater risk compared to the general population, making them an ideal population for screening.

"There are even some pediatricians starting to implement screening. The problem is that you have to set up this infrastructure to screen people, and then it takes time before you have those patients that are going to be eligible for treatment," explained Kimber Simmons, MD, MS, associate professor of pediatrics at the Barbara Davis Center for Diabetes at University of Colorado.

Kimber Simmons, MD, MS, Associate Professor of Pediatrics at the Barbara Davis Center for Diabetes at University of Colorado

Despite growing enthusiasm among endocrinologists, screening remains inconsistent across the country. Before teplizumab's approval, many doctors debated whether screening was even necessary. Today, most health care professionals agree that screening people with a family history is important, but implementation lags behind the science.

How to Understand Type 1 Diabetes Screening and Monitoring

• Initial Autoantibody Testing: Health care professionals use blood tests to detect islet autoantibodies, which signal that the immune system is attacking the insulin-producing cells in the pancreas. This test can identify the disease years before symptoms appear.
• Staging and Risk Stratification: People who test positive for one autoantibody require periodic retesting. Those with two or more confirmed autoantibodies are considered to have presymptomatic type 1 diabetes and need regular glucose monitoring to watch for progression to stage 3.
• Monitoring Frequency by Age: Children with multiple islet autoantibodies should have glucose checked every 3 to 12 months because the disease progresses more quickly in young children. Adults with multiple autoantibodies typically need annual monitoring, as the disease progresses much more slowly in adults.
• Education and Support: People identified through screening should receive education about the disease, psychosocial support, and information about clinical trials for emerging therapies.

An international consensus guidance published jointly in Diabetes Care and Diabetologia in 2024 established these monitoring standards to help health care professionals manage patients after screening.

The difference in disease progression between children and adults is significant. Very young children with type 1 diabetes experience rapid progression toward symptomatic disease, while adult-onset type 1 diabetes typically progresses much more slowly. However, most research on screening over the past three decades has focused on children, leaving gaps in understanding how to best monitor and treat adults.

What Barriers Stand in the Way of Widespread Screening?

Despite the scientific case for screening, several obstacles prevent it from becoming routine. Setting up screening infrastructure requires resources, training, and coordination among health care systems. Additionally, there is a gap between identifying people at risk and having enough patients eligible for treatment, since not everyone with autoantibodies will progress to symptomatic disease.

"Type 1 diabetes screening is not being conducted as often as it should be, even though some health care professionals are calling for the implementation of general population screening for the disease. A lack of screening has limited the number of people eligible to receive teplizumab-mzwv," noted Archana Sadhu, MD, system director of the diabetes program at Houston Methodist.

Archana Sadhu, MD, System Director of the Diabetes Program at Houston Methodist

Education is another critical gap. Many health care professionals lack training on the early stages of type 1 diabetes, how to interpret autoantibody results, and how to counsel patients about screening and monitoring. This knowledge gap slows adoption of screening protocols.

"We are a field that is at an inflection point, and as a clinical community, we need to embrace this pivot. While the cause of type 1 diabetes is autoimmune, clinical management is wholly focused on the metabolic effects. We need to start thinking about this as an autoimmune disease, because we now have tools to identify it early through screening and intervene," stated Anastasia Albanese-O'Neill, PhD, APRN, CDCES, vice president of medical affairs at Breakthrough T1D.

Anastasia Albanese-O'Neill, PhD, APRN, CDCES, Vice President of Medical Affairs at Breakthrough T1D

Experts emphasize that this represents a fundamental change in how the medical community thinks about type 1 diabetes. Rather than waiting for symptoms to develop, the field is moving toward early detection and intervention. However, this shift requires investment in screening infrastructure, education for health care providers, and clear guidelines for monitoring and treatment.

Multiple organizations have released updated recommendations to support this transition. The American Diabetes Association 2026 Standards of Care provide guidance on who should be screened and how results should be interpreted. Breakthrough T1D has also spearheaded a draft consensus screening guidance that focuses on general population screening, proposing that islet autoantibody screening be offered to the general population where policy and infrastructure are in place.

As more health care professionals adopt screening protocols and more patients are identified early, the potential to prevent or delay type 1 diabetes onset grows. The challenge now is ensuring that screening becomes standard practice, not an exception, and that patients identified through screening have access to the therapies and support they need.