Strategies to Improve Screening and Diagnosis of T1D

Robert Busch, MD: Before we close, now that we have this exciting tool, what will each of you be doing in your own center for your patients and for your group to screen patients and get this tool on board, assuming it is paid for, which is a very big assumption, and assuming you’ll have the capability to have a 14-day infusion somewhere. Who will you be screening, and how will you spread the word among your colleagues within your own groups? Dr Goland, why don’t we start? We’ll go around, then you, Dr Simmons, and Dr Quattrin, so I can learn and steal the best-case scenario from each of you.

Robin S. Goland, MD: I’m waiting for more information about the rollout. Patients and family members who specifically want the drug will do the antibody screening commercially. We are going to come up with our plan, which will involve some element of home care, I hope, because I think that would be the easiest for the patients. It’s difficult to get around in New York, but we’re working out the details.

Robert Busch, MD: Dr Simmons, anything different that you’d be doing?

Kimberly Simmons, MD, MPH/MSPH: As we’ve talked about, people with a family history are at highest risk. Those are the people who we definitely have always tried hard to get screened. The messaging now when you say the same thing is a lot more interesting with something being available. I’m hoping that the same messaging we’ve been giving about getting our relatives screened will result in more screening happening through TrialNet, for example. We also have the opportunity to do general population screening in Colorado. We’re working with a lot of pediatric education health networks through our system to get the word out to let people know they can be screened. The autoimmunity for children study can screen remotely now too, so we’re working with places that don’t have the opportunity to screen or even a great laboratory option for commercial antibodies, where we can help do screening remotely. I’m also helping to lead a project called Ask the Experts, where if somebody tests positive for antibodies in an area that’s more rural and doesn’t have support, we try to work with a local provider to train them on how to support that patient, and then in the meantime can provide remote care.

That is kind of a big picture of how we’re going to do screening. Hopefully, in lots of people and supporting lots of people. As far as administering teplizumab, there are many details to work out, but I have the privilege of being involved in starting an early type 1 diabetes clinic at our center. So we’re hoping to be able to administer the medication at our center once we work out all of the logistics.

Robert Busch, MD: Dr Quattrin, anything different you’ll be doing?

Teresa Quattrin, MD: Informing all health care professionals that this is available is important, and making it easy for them to order these antibodies, telling them, this lab, this code, make it easy so they don’t have to spend a lot of time. In terms of a systemic and sustainable approach, there is a need for lobbying. In New York state, and Dr Goland knows, we screen for conditions that are far rarer than T1D [type 1 diabetes]. The difference and impact in addressing and preventing, or diagnosing early, may not be as relevant in terms of cost-benefit. I think we need to also lobby, and from my standpoint until I can do something like that, I’m going try to connect with Kimberly’s group and any other group to try to test as many people as possible.

As far as the practical implications, the pediatrician is the captain of the ship, so the family will talk with them. They always do when we’re proposing a trial, and we often talk with them ourselves. When you hear even the remote possibility of cytokine release syndrome, there is an uneasiness. It’s important that the data that are available regarding the timing of when these adverse effects occur, which is usually earlier, not only the incidence but the timing and the severity, is widely explained and available because it makes a difference when you might be able to do 3 injections at the site and the rest of the infusion possibly at home. I don’t know that right now my colleagues and I would feel comfortable with the treatment being done at home. There are tons of details to be worked out in terms of being able to administer the new medicine.

Robert Busch, MD: What I plan on doing in my own site, I work with 15 adult endocrinologists. First, I have a call tomorrow with the chief of medicine to say, if there’s any interest, we could be an infusion site. I know we don’t know the logistics yet, will it be initiated in the office, as you said, and then the rest at home, or some kind of hybrid model of that? But to do a mass mailing like the way I would normally solicit patients for clinical trials, we could leverage our electronic records. I could identify everyone in the practice with type 1 diabetes and have an appropriately crafted letter talking about the antibodies. Of course, they’d have to check to see if the antibody levels are covered, and where they can get them free or for a reasonable price commercially available. But I wouldn’t send that letter until we have the tool to do something about it, not just to inform them about it. Either they’ll go to a pediatric endocrinologist if it’s positive for the rest of the work-up, to their adult endocrinologist, or a referral or something like that to do this bigger time, to be able to do that. It’s such an exciting tool for all of us, and you’ve all made me more enthusiastic for what’s on the horizon.

I’d like to thank all of you for this rich and informative discussion. Before we conclude, I’d like to get any final thoughts from each of you on what key message you would give to your colleagues. We’ll start with you, Dr Goland.

Robin S. Goland, MD: This is a very exciting time for people with type 1 diabetes and their relatives. On the horizon are opportunities for delay and eventually prevention and cure of type 1 diabetes. Stay tuned.

Robert Busch, MD: Dr Simmons?

Kimberly Simmons, MD, MPH/MSPH: I would say the door has now opened, which is extremely exciting, and I look forward to seeing what comes through the door in the future. I think everyone should feel very excited and hopeful, and not overwhelmed, because it can be very overwhelming. There’s so much information. There are great resources out there to support anyone who is interested in screening, or potentially administering a medication, or interested in a clinical trial. The Juvenile Diabetes Research Foundation has a page on how to get screened. TrialNet, of course, has information on how to get screened. The Autoimmunity Screening for Kids program has information on screening. You have at least 3 great resources to reach out to, to get support.

Robert Busch, MD: Dr Quattrin?

Teresa Quattrin, MD: I echo what Drs Goland and Simmons said. It seems almost like a dream for those of us who have been involved in this field for such a long time. People with type 1 diabetes deserve this and they deserve more. There’s so much innovation that if we can delay the onset, they may be able to take advantage of those innovations and new therapies. It’s important that we are not in a silo as subspecialists, but rather we collaborate with all the health care professionals. As I mentioned, I know TrialNet can mail a kit, and there are other efforts that make things possible for families to look at this and look at the future as a brighter future.

Robert Busch, MD: Well, thank you. I’ve learned a great deal from each of you. If our audience even learns a fraction of what I’ve learned, it’s very successful. Thanks for watching this Peer Exchange on “The Future of Type 1 Diabetes Management.” If you enjoyed the content, please subscribe to the e-newsletters to receive upcoming peer exchanges and other great content in your inbox. The material contained in this document is the property of Intellisphere LLC and should be considered confidential for internal purposes. Thank you very much for joining us.

Transcript Edited for Clarity