26 - Type 1 Diabetes: From autoimmune origin to cardiometabolic consequences (15 min)

Summary

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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

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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.

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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]

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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]

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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]

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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]

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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.

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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]

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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

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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 |

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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.

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Transcript

[A]

Foreign. Welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from Insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine, and wellness medicine. Type 1 diabetes makes up only a fraction of total diabetic cases globally, but its impact is profound and growing. An estimated 2 million Americans are living with type 1 diabetes. And while previously thought to be a childhood diagnosis, many adults are now being diagnosed, too. Unlike many of the cardiometabolic conditions that we discuss here on healthier world, type 1 diabetes is not preventable through diet and lifestyle, but rather, type 1 diabetes is an autoimmune condition that requires lifelong insulin therapy and careful management. I'm Dr. Mason Latsko, and today on the podcast, I have Franklin Warren, product manager for the cardiometabolics segment at Quest Diagnostics, and he'll be here to discuss type 1 diabetes with me. Welcome, Franklin.

[B]

Hi, Mason. I'm excited to be here, and I'm excited to talk about this really important topic.

[A]

Well, it's great to have you on. I'm looking forward to it. So, on this podcast, as you're well aware, we often talk about metabolic dysfunction and type 2 diabetes. And these are conditions that occur as our bodies respond to continual exposure to high levels of glucose or blood sugar. And in type 2 diabetes, our insulin just really can't keep up with the overabundance of glucose that we're experiencing. And so over time, we develop insulin resistance and a decline in beta cell function. And these are the cells in the pancreas that produce our insulin. And eventually, these patients have high fasting A1C warranting a type 2 diabetes diagnosis. So in type 2 diabetes, it's really the inability for our body to respond to the signal of insulin that becomes the problem. But when we're Talking about type 1 diabetes, we're telling quite a different story, right, because it's not caused by poor diet and lifestyle. And in contrast, it's an autoimmune condition. So, Franklin, can you expand on that? What exactly is type 1 diabetes, and how does it differ from the traditional story that we've been telling about type 2 diabetes?

[B]

So, Mason, that's exactly right. 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. It's important to know that genetic and environmental factors actually trigger the body to produce these autoantibodies, and that's what coordinates the attack on the pancreatic cells responsible for insulin production. And this lack of insulin production is what causes the high levels of circulating glucose, which could damage organs and their metabolic processes. So this leads to some of the same cardiometabolic consequences as T2D.

[A]

Right. So, similar to the idea of the development of type 2 diabetes, patients with type 1 diabetes also have an issue with their insulin production and high levels of circulating glucose. But in this instance, it's caused by an autoimmune condition. And I think that's really important to note that, because the outcomes are the same. Type 1 and Type 2 diabetes do have some overlapping cardiometabolic consequences due to poor glycemic control. But another thing that sets type 1 diabetes apart is the idea that type 1 diabetes was traditionally labeled as a childhood disease. But now we know that's actually not the full story. So can you talk a little bit about how common type 1 diabetes is and who is typically being diagnosed with type 1 diabetes?

[B]

Sure. So, as you mentioned, over 2 million Americans are currently living with T1D. And due to the strong genetic aspects of the disease, that means that more than 10 million Americans are actually at risk of developing the disease at some point in their lifetime. And T1D was once thought of as only a disease diagnosed in childhood. In fact, it used to be called juvenile diabetes for that very reason. Yet most people living with T1D are actually adults. That's why the condition is now known as autoimmune diabetes or T1D.

[A]

So more than 50% of new cases of type 1 diabetes are diagnosed in adulthood. That's really impactful. And that really does emphasize the need for better identification of patients with type 1 diabetes. To add to that, I know that the prevalence of type 1 diabetes in adults is relatively under recognized. And in fact, a lot of adults are misdiagnosed with type 2 diabetes when they actually have type 1 diabetes. Why is that?

[B]

That is a great question, Mason. So T1D is underdiagnosed in adults and it is often misdiagnosed as T2D. There are several reasons for that. The first one is in children. The signs and symptoms of T1D come on very quickly and are very obvious. Disease progression happens much more slowly in adults. Also, the gold standard biomarker testing to diagnose diabetes, which is hemoglobin A1C and glucose are going to be elevated in both conditions. So T1D and T2D are going to look the same from that aspect. If you pair the traditional thinking of T1D as a childhood disease with the fact that the tools used to diagnose both conditions are the same, it's easy to see why T1D is often missed in adults. The situation is made even worse by the growing epidemic of insulin resistance, obesity, and other metabolic abnormalities in the general population. So traditional measures of looking at leaner body mass as a way to differentially diagnose T1D and T2D in adults no longer apply. 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. That's a critical differentiator between the two conditions.

[A]

So the emphasis that we can't necessarily look at a patient and identify whether they're type 1 or type 2 diabetics based on age or body composition, it's is a really great point. Instead, we must identify the root cause of the high blood sugar, whether it be beta cell loss due to an autoimmune condition, as is the case in type 1 diabetes or insulin resistance in type 2 diabetes. Now, as you mentioned, there are some serious complications with type 1 diabetes, and I'd like to dig into that a little deeper here. Can you expand on the clinical presentation for a type 1 diabetic patient?

[B]

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 a condition known as diabetic ketoacidosis.

[A]

And just to clarify for the audience here, DKA is a serious complication that results when the body can't make enough insulin and it starts to break down fat for energy. And this process produces acidic substances known as ketones, which accumulate in the blood and lead to dka.

[B]

That's exactly right, Mason. Additionally, because of the Factors we discussed, 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. So diabetic ketoacidosis, or dka, is a medical emergency. It requires ICU hospitalization and predisposes patients to much poorer health consequences. Because 90% of T1E patients do not have a known family history, patients and their families may not recognize the severity of the situation until this urgent hospitalization is required.

[A]

Yeah, great point. That if patients aren't aware that they're type 1 diabetics, they may not be aware to look out for signs and symptoms of dka and not just patients, but their families. And that Includes parents, which I think resonates with many of us out there. Now, your emphasis with DKA and the particular complications associated with type 1 diabetes really does sound like early intervention is crucial in order to identify or delay these complications from arising. And recently, we know that the American Diabetes association updated its guidance to support screening for type 1 diabetes. Can you speak a little bit about these guidelines and what they recommend?

[B]

Yeah. So now the American Diabetes association recommends Screening for type 1 diabetes Autoantibodies, especially among patients with a family history of type 1 diabetes or other genetic risk factors, which can include history of autoimmune condition. Along with screening, the ADA and other groups have developed consensus guidance for monitoring individuals with autoantibody positivity. So in this case, individuals may still be asymptomatic but have positive autoantibodies. For those patients, things like more frequent metabolic monitoring with tests like HbA1c and glucose are recommended, as well as a list of specific signs and symptoms for those patients and everyone they interact with to watch out for. This helps prevent them landing in the ER with diabetic ketoacidosis, and it sets them up for much better metabolic health into the future.

[A]

Yeah, that's great to know and great guidance. The idea that screening can significantly reduce the risk for developing DKA and allow these patients to be proactive in their health and give them time to prepare for this condition and potentially participate in treatments that can help delay the onset of type 1 diabetes. Right now, the autoantibodies that are supported by the ADA include glutamic acid decarboxylase 65 autoantibody, the insulin autoantibody, the IA2 antibody, and the zinc transporter 8 antibody. In order for Quest Diagnostics to align with ADA, we brought forth a panel that offers all four of these autoantibodies in one single test code. And you can use this panel to screen and diagnose type 1 diabetes, to differentiate from type 2 diabetes, to predict progression from stage 1 to stage 3 type 1 diabetes, and to determine eligibility for certain medications. Now, given the profound impact of type 1 diabetes and complications that we mentioned previously, I want to dig into why this screening wasn't previously supported by the ada. Can you tell me what are the differences in terms of available therapies, preventative approaches, and how does that influence how we think about screening for type 1 diabetes?

[B]

That's right, Mason. Traditionally, these biomarkers were only used to confirm type 1 diabetes diagnosis, and that mostly happened when there were those overt signs and symptoms. That we mentioned earlier. In those cases, as you alluded to, the only form of treatment was exogenous insulin. So there was no need to screen patients until they actually needed the insulin. But now, due to advancement in treatment options, including stem cell therapies and others that are being developed, as well as newly approved drugs that actually maintain or rescue beta cell function, there's a critical reason to screen. Additionally, as we have already mentioned, preventing DKA is an enormous reason to screen. Studies have shown that when first degree relatives are Screened for type 1 diabetes, rates of DKA at diagnosis can drop from 30% to as low as 3%. A single incidence of DKA can cost upwards of $30,000. So this not only helps maintain better health for patients, but but also maintains better healthcare spending dollars.

[A]

Wow. When a single DKA event can cost upwards of $30,000, then dropping it from 30% to 3%. Using these screening tools is a huge deal for our healthcare system. Now, I want to go full circle here and talk about something that we alluded to at the very beginning of the podcast when we talked about how patients with type 2 diabetes and type 1 diabetes often present with symptoms similar outcomes, including dysglycemia and reduced insulin function. Although the source of the issue is different between type 1 and type 2 diabetics, can you go into how type 1 diabetes patients still experience many other comorbid cardiometabolic conditions as the result of these metabolic changes?

[B]

That's exactly right, Mason. We do need to think of this not only as an autoimmune condition, but also as a cardiometabolic condition. The autoimmune aspect speaks to the way the disease starts and progresses, but the cardiometabolic outcomes are just as important to consider and also monitor throughout the lifetime of these patients. So 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. This also leads to vascular injury to your kidneys, increasing incidences of chronic kidney disease. Additionally, there's other conditions that can occur which include fatty liver disease and other cardiometabolic outcomes that affect your endocrine system as well. So as a whole, type 1 diabetes is a form of diabetes that has the same cardiometabolic effects and outcomes as any of the other conditions that we commonly discussed. So while the origin of the disease is different, the outcomes are the same, and so it can have similar impacts.

[A]

Yeah, and I know we've mentioned that a few times, but I think that's what's so profound to me about type 1 diabetes. Oftentimes we talk about disease states that are preventable. To some extent they are. They're usually disease states that can be intervened upon using diet and lifestyle changes. And with type 1 diabetes, that's not really what we're dealing with. We're talking about an autoimmune condition that could have just as profound impacts on the heart and the patient's metabolic health. And I think that there needs to be a lot more education around that.

[B]

That's so true, Mason. I think what's really important for me in this respect that speaks to what you just said is as a metabolic product manager, I talk every day about these conditions as well as the tools that we have to help providers manage and identify these patients at risk of for these diseases that are mainly influenced by lifestyle management. 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. So with this panel, we can now identify those who may be at risk, as well as manage those who are progressing through that risk to avoid things like dka, which prior to now we didn't have the ability to do. So.

[A]

Yeah, absolutely. Well said. And I really appreciate you coming on here, Franklin. Quest Diagnostics is grateful to have you supporting and leading the charge with type 1 diabetes. Until next time.

[B]

Thanks for having me, Mason.

[A]

That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.