An estimated 1.8 million people in the United States, or nearly 1 in 250 children and 1 in 200 adults , have type 1 diabetes . One-third of children with type 1 diabetes are diagnosed when they develop diabetic ketoacidosis (DKA), which is not only life-threatening in the short term but is associated with poor long-term glycemic control . First-degree relatives are 15 times as likely as the general population to have type 1 diabetes, and the American Diabetes Association recommends testing them for pancreatic islet autoantibodies to predict whether they will develop the disease. In a prospective study , children previously identified as being at high risk of type 1 diabetes based on autoantibodies had a low incidence of DKA (3.3%) at the time of diagnosis. Not only does the presence of islet autoantibodies have prognostic significance, selected patients may be eligible for teplizumab (Tzield), a monoclonal antibody approved by the U.S. Food and Drug Administration in 2022 to delay