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The pandemic has altered how patients access and use health care. Now is the time for primary care clinicians to rebuild important connections with them. 

How to Keep Patients Engaged with Primary Care 

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

Clinical Topics

White Knuckles

A 13-year-old girl with known eczema presents with a vesicular rash on her palms that appeared after swimming in the ocean. Skin is tender; vesicles ooze clear liquid. Treated with triamcinolone w/o effect. Watch real-time examination on video.

A. Acute palmoplantar eczema (dyshidrotic eczema)

VIDEO: The child's hands are chronically dry but the skin has recently begun to crack; vesicular rash appeared after an ocean swim. Dx?

A 13-year-old Girl with a Vesicular Rash on Palms 

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

Teplizumab Use in Practice

Panelists discuss how teplizumab use in practice involves careful patient selection, navigating approval processes, and managing the 14-day infusion regimen to optimize outcomes and delay the progression of type 1 diabetes.

Video Series

Teplizumab Therapy to Delay Onset and Progression of T1D 

Panelists discuss how teplizumab therapy can delay the onset and progression of type 1 diabetes (T1D) by preserving β-cell function and reducing the risk of developing full-blown diabetes in at-risk individuals.

Antibody Screening for T1D

How do we typically screen primary populations for type 1 diabetes risk factors during routine appointments? Is it:

Clinical assessment of symptoms and risk factors?

Most people focus on autoantibody testing, which remains the gold standard. Dr. Choudhary, can you walk us through the current recommendations for screening?

 Absolutely. The risk of developing type 1 diabetes in the general population is approximately 1 in 300. For first-degree relatives, it increases significantly to 1 in 20—a 15-fold higher risk.

The ADA and ISPAD guidelines recommend screening first-degree relatives and individuals with other autoimmune conditions, such as Hashimoto's thyroiditis and celiac disease, which are associated with a 2-3 times higher risk compared to the general population. While specific HLA genotypes are also risk markers, these are typically evaluated in research settings rather than routine practice. Key takeaway: Focus screening on first-degree relatives and individuals with autoimmune diseases like Hashimoto's and celiac.

As for when to begin screening, there’s no definitive guideline. Some experts suggest starting at birth, others at age two. The TrialNe

 study recommends starting at 2.5 years of age, and we'll discuss more about available screening options shortly.

 That’s insightful. I think other autoimmune conditions, such as vitiligo or pernicious anemia, might also warrant consideration. What are your thoughts?

: I think While these conditions carry some risk, the association isn’t as strong as with Hashimoto's and celiac disease. However, their presence could still justify additional screening.

Let’s explore another question: How familiar are you with the concept of antibody levels as biomarkers for disease progression and treatment response in type 1 diabetes? Options:

Dr. Choudhary, are quantitative antibody levels now commonly measured?

 Yes, quantitative levels are increasingly used and often repeated to monitor progression. We’ll discuss their role shortly.

I'm happy to see that two-thirds of our audience is actually very familiar with this concept of antibody level. Natalie, would you be kind enough to chime in and walk us through these types of antibody screenings for type ones?

Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES:

 Certainly. Several screening options are available. In our practice, we use Epic to consolidate a “Type 1 Screen” order set for autoantibodies, which can be sent to commercial labs like Quest or LabCorp.

Two major research studies also offer free screening:

Panelists discuss how antibody screening for type 1 diabetes can identify at-risk individuals early, enabling proactive monitoring and intervention to delay or prevent disease onset.

Jill Warren

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