### Balancing the Challenges of Type 1 Diabetes: A Pediatric Endocrinologist’s Path to Advocacy and Awareness

Type 1 diabetes (T1D) is a condition layered with complexity, impacting both physiological and emotional aspects. For Dr. Shara Bialo—a board-certified pediatric endocrinologist, the medical director for T1D immunology at Sanofi, and someone who has been living with T1D since her youth—the expedition is not solely a professional endeavor; it is deeply personal. Her experience as both a physician and a parent highlights the intertwined challenges and duties of traversing the landscape of T1D while fervently advocating for awareness, prevention, and support.

#### Risk Factors and the Necessity for Early Detection

From a clinical perspective, T1D is a condition we comprehend thoroughly regarding its risk factors. For those with a family history of T1D, the probability of developing the condition elevates by as much as **15 times**, emphasizing the critical nature of early detection in vulnerable groups. More frequently, **T1D autoantibody screening**, a method that identifies risk indicators even prior to the onset of symptoms, is emerging as a vital public health concern. Proactive screening can facilitate preventive care and avert severe complications such as **diabetic ketoacidosis (DKA)**—a critical emergency that frequently arises with an undiagnosed case of T1D.

Dr. Bialo’s experience as a mother to children with a genetic inclination towards T1D highlights how even experts in the field can feel hesitation and emotional turmoil. “I dealt with guilt and shame at the thought of possibly passing on the condition,” she revealed. Nevertheless, she ultimately decided to have her children screened, a choice she now advocates for others. Her experience emphasizes a vital truth: **awareness and education extend beyond mere information—they involve confronting emotional obstacles that can hinder decisive action.**

#### Tackling Gender Discrepancies in Screening and Awareness

A survey organized by Beyond Type 1 in collaboration with Sanofi—fittingly titled **”The Cost of Not Knowing”**—uncovered concerning discrepancies in awareness, especially along gender lines. While approximately half of women with T1D regarded themselves as proactive about their health, only **20 percent underwent screening prior to diagnosis.** In contrast, men with T1D were notably more informed about screening and received diagnosis before significant symptoms became apparent.

The implications of delayed awareness are striking: according to the same survey, nearly **97 percent of women** with T1D felt their health outcomes would have improved had they been aware of their risk sooner. Additionally, **86 percent expressed that their lives would have taken a different trajectory** if they had been diagnosed earlier and managed their condition more proactively.

Such insights underscore the pressing need for **targeted education, particularly for women**—not just as individuals but as caregivers and advocates within their families. Women frequently act as guardians of health information for their children, siblings, and partners, magnifying the impact of screening awareness. This reveals an essential area where healthcare professionals (HCPs) can intensify their efforts to close the gaps in understanding and access.

#### The Emotional Burden of an Unseen Struggle

T1D, although predominantly managed through medical measures like insulin therapy, casts a profound emotional shadow over those affected. Beyond the physical trials of monitoring blood sugar, dietary modifications, and risks of complications, there’s a psychological impact. Feelings of guilt, anxiety, and dread often accompany family dialogues surrounding genetic risk and the chance of transmitting the condition. This emotional load can deter even those in high-risk families from pursuing preventive actions such as autoantibody screening.

Dr. Bialo’s openness in sharing her challenges as a mother resonates with countless untold stories from families facing similar struggles. Her acknowledgment—that her reluctance stemmed not from a deficiency in medical knowledge but from profound personal guilt—serves as an essential reminder: healthcare choices are frequently driven by emotional aspects as much as by intellect.

For healthcare providers, ensuring that patients and their families receive emotional support is just as critical as delivering clinical advice. This involves creating an atmosphere of **open dialogue and non-judgmental care**, where individuals feel motivated to make informed choices without the burden of stigma, shame, or fear.

#### Embracing a Proactive Stance

Addressing the extensive knowledge deficit about T1D screening necessitates a multifaceted strategy, particularly concerning empowering women and families:

1. **Raising Public Awareness**: Many individuals, particularly women, may remain unaware that T1D screening is available. Public health initiatives, outreach via social media, and collaborations with organizations like Beyond Type 1 can significantly contribute to spreading this information broadly.

2. **Customized Messaging**: Understanding that women often juggle numerous responsibilities—as caregivers, professionals, and decision-makers—educational initiatives must resonate with their distinct experiences. Messaging