Podcast Summary

Healthier World with Quest Diagnostics

Episode: Type 1 Diabetes: From Autoimmune Origin to Cardiometabolic Consequences
Release Date: November 17, 2025
Host: Dr. Mason Latsko
Guest: Franklin Warren, Product Manager, Cardiometabolics, Quest Diagnostics
Length: ~15 minutes

Overview: Episode Theme and Purpose

This episode examines Type 1 Diabetes (T1D)—from its autoimmune origins to its profound cardiometabolic consequences—highlighting crucial distinctions between T1D and Type 2 Diabetes (T2D), clinical challenges in diagnosis (especially in adults), risks such as diabetic ketoacidosis (DKA), and evolving recommendations for screening and management. The discussion also focuses on the pivotal role of diagnostic advancements in improving prevention and outcomes.

Key Discussion Points and Insights

1. Distinct Origins of Type 1 Diabetes vs. Type 2 Diabetes

• Type 2 Diabetes (T2D) is typically linked to metabolic dysfunction—primarily insulin resistance due to lifestyle and environmental factors.
  • “In type 2 diabetes, it's really the inability for our body to respond to the signal of insulin that becomes the problem.” —Dr. Mason Latsko [01:37]
• Type 1 Diabetes (T1D) is an autoimmune disorder caused by immune-mediated destruction of pancreatic beta cells.
  • “Type 1 diabetes is an autoimmune condition where the immune system destroys the insulin producing beta cells, which does eventually lead to absolute insulin deficiency.” —Franklin Warren [02:16]
• Key insight: T1D is not preventable through diet or lifestyle.

2. Epidemiology and Shifting Demographics

• While previously known as "juvenile diabetes," T1D is now more frequently diagnosed in adults.
  • “More than 50% of new cases of type 1 diabetes are diagnosed in adulthood. That's really impactful.” —Dr. Mason Latsko [04:09]
• Over 2 million Americans live with T1D; more than 10 million are at risk.
• The adult prevalence is under-recognized; misdiagnosis as T2D is common.

3. Challenges in Diagnosis—Misdiagnosis in Adults

• Symptoms and disease progression in adults can be subtle and slower, increasing the risk of misclassification.
  • “T1D is underdiagnosed in adults and it is often misdiagnosed as T2D... Disease progression happens much more slowly in adults.” —Franklin Warren [04:35]
• Standard biomarkers (A1C and glucose) do not distinguish between T1D and T2D.
  • Quote: “Age and obesity are no longer enough to rule out type 1 diabetes. What's really important is understanding the underlying cause of the high blood sugar.” —Franklin Warren [05:38]

4. Clinical Presentation and Acute Complications

• Classic symptoms: Increased thirst, frequent urination, weight loss.
• Critical risk: Up to 30% of children (and many misdiagnosed adults) present with diabetic ketoacidosis (DKA).
  • “The most frequent clinical presentation is increased thirst, frequent urination, and weight loss. But the most critical one to be aware of is that up to 30% of children with T1D actually present in the ER with... diabetic ketoacidosis.” —Franklin Warren [06:22–06:38]
  • DKA is a medical emergency, “requires ICU hospitalization and predisposes patients to much poorer health consequences” (Franklin Warren [06:56]).
• Misdiagnosis increases risk: “40% of adults who are eventually diagnosed with T1D were originally misdiagnosed as T2D. So they also can end up having incidences of diabetic ketoacidosis.” —Franklin Warren [06:56]

5. ADA Guidelines and The Case for Autoantibody Screening

• Recent ADA changes: Screening for T1D autoantibodies is now recommended, especially in those with family history or genetic risk factors.

  • “The ADA and other groups have developed consensus guidance for monitoring individuals with autoantibody positivity.” —Franklin Warren [08:21]

• Screening helps:

  • Early identification and monitoring,
  • Reduces risk of DKA at diagnosis (“rates of DKA at diagnosis can drop from 30% to as low as 3% when first degree relatives are screened for type 1 diabetes.” [10:57])
  • Opens doors for emerging preventive therapies.

• Quest Diagnostics Panel: Offers all four ADA-supported autoantibodies in one test, aiding diagnosis, risk assessment, and treatment eligibility.

  • “You can use this panel to screen and diagnose type 1 diabetes, to differentiate from type 2 diabetes, to predict progression... and to determine eligibility for certain medications.” —Dr. Mason Latsko [09:30]

6. Therapeutic Advances – Why Screening Makes Sense Now

• In the past, absence of disease-modifying therapies made screening less useful.
  • “The only form of treatment was exogenous insulin. So there was no need to screen patients until they actually needed the insulin.” —Franklin Warren [10:29]
• Now: Options include drugs that preserve beta cell function, stem cell therapies in development—making early detection valuable.
• Healthcare cost impact: Avoiding DKA is not only life-saving, but cost-saving.
  • “A single incidence of DKA can cost upwards of $30,000. So this not only helps maintain better health for patients, but also maintains better healthcare spending dollars.” —Franklin Warren [11:12]

7. Cardiometabolic Consequences of T1D

• Despite different origins, T1D and T2D share similar long-term health risks:
  • Cardiovascular disease (atherosclerosis, hypertension)
  • Chronic kidney disease
  • Fatty liver disease, other endocrine/metabolic complications
  • “People with T1D face many of the same risks and consequences as people with T2D. This includes chronic high blood sugar, which can damage blood vessels over time, leading to atherosclerosis, hypertension, and eventually cardiovascular disease.” —Franklin Warren [12:22]

8. The Importance of Education and Provider Tools

• Type 1 diabetes requires as much awareness and proactive management as Type 2—and now, with autoantibody testing, providers can do more.
  • “The beauty of the type 1 diabetes autoantibody panel is that it now allows us to have tools to do the same thing for an autoimmune condition, which arises from factors that are completely out of the patient's control.” —Franklin Warren [13:51]
• Early identification empowers patients and families, especially since most do not have a family history of T1D.

Notable Quotes & Memorable Moments

• “More than 50% of new cases of type 1 diabetes are diagnosed in adulthood.” —Dr. Mason Latsko [04:09]
• “40% of adults who are eventually diagnosed with T1D were originally misdiagnosed as T2D.” —Franklin Warren [06:56]
• “When first degree relatives are screened for type 1 diabetes, rates of DKA at diagnosis can drop from 30% to as low as 3%.” —Franklin Warren [11:12]
• “A single incidence of DKA can cost upwards of $30,000.” —Franklin Warren [11:28]
• “While the origin of the disease is different, the outcomes are the same, and so it can have similar impacts.” —Franklin Warren [13:09]
• “With this panel, we can now identify those who may be at risk…which prior to now we didn't have the ability to do.” —Franklin Warren [13:51]

Key Timestamps for Important Segments

• [01:37] — Differentiating T1D from T2D: pathophysiology breakdown
• [02:16] — T1D as autoimmune disease
• [04:09] — Adult-onset T1D and prevalence statistics
• [04:35] - [05:47] — Challenges in T1D diagnosis and misdiagnosis in adults
• [06:22] - [06:38] — Typical T1D presentation & diabetic ketoacidosis
• [08:11] — ADA screening recommendations and rationale
• [09:30] — Description of the Quest Diagnostics autoantibody panel
• [10:29] - [11:28] — Advances in treatment and prevention of DKA
• [12:12] - [13:09] — Cardiometabolic consequences: parallels between T1D and T2D
• [13:51] — The transformative potential of autoantibody testing for T1D

Summary Table: T1D Essentials Covered in This Episode

| Topic/Issue | Key Points | |--------------------------|--------------------------------------------------------------------------------------------------------------------------------| | Origin | Autoimmune beta cell destruction; not lifestyle-induced | | Age of Onset | >50% of new cases are adults; adult-onset under-recognized | | Diagnosis Challenges | Overlapping biomarkers; slow symptoms in adults; frequent misdiagnosis as T2D | | Acute Complications | DKA is common, serious, expensive | | Screening Recommendations| ADA now endorses autoantibody screening | | Treatment Advances | New therapies make early detection impactful | | Cardiometabolic Risks | T1D and T2D have similar long-term vascular and metabolic complications | | Value of Early Detection | Prevents DKA, costly care; improves outcomes and education |

Closing

This episode offers a compelling case for newer screening strategies, early identification, and a shift in mindset regarding Type 1 Diabetes—presenting it as not only a childhood autoimmune disorder, but a lifelong, potentially adult-onset, cardiometabolic disease with wide-reaching health and cost consequences. Tools like comprehensive autoantibody testing are paving the way for earlier diagnosis, improved prevention, and better lives for patients.