Rady Children’s delivers personalized care to help kids and teens living with Type 1 diabetes thrive
A diagnosis of Type 1 diabetes can turn a family’s world upside down. But in San Diego, families do not have to face that journey alone. The Type 1 Diabetes Program at Rady Children’s Hospital San Diego brings together pediatric specialists, advanced treatment options and ongoing education to support young patients and their families.
The message is clear: Managing Type 1 diabetes (T1D) is a daily responsibility, but it does not have to define a child’s life.
Rady Children’s cares for more than 1,500 children living with T1D and diagnoses roughly 200 new cases each year. Led by Carla Demeterco-Berggren, MD, PhD, director of Rady Children’s Diabetes Program and a clinical professor of pediatrics at UC San Diego, the Hospital is helping lead a shift in how T1D is understood, diagnosed and treated.
Excellence and Equity in Diabetes Care
Rady Children’s has emerged as a national leader in pediatric diabetes care, driven by a sustained commitment to innovation, equity and measurable improvements in outcomes for children and families living with T1D.
Over the past five years, the program has helped more children and teens live healthier lives with T1D. Progress is tracked using hemoglobin A1C, an important marker of diabetes health that reflects average blood sugar levels over time. Since 2021, more than twice as many youths are reaching recommended A1C goals, reflecting positive changes families can see and feel in their day-to-day lives.
These gains are the result of a deliberate transformation in care delivery grounded in implementation science and population health strategies. As part of this effort, Rady Children’s joined the T1D Exchange Quality Improvement Collaborative, the county’s first nationwide learning collaborative dedicated to people with T1D. Through this partnership, the Hospital has accelerated quality improvement initiatives, strengthened health care delivery and health equity, and improved outcomes by benchmarking performance and sharing best practices across leading pediatric diabetes centers.
As a result, more families now have access to diabetes technologies that support everyday care and peace of mind. Use of insulin pumps among publicly insured patients has increased nearly threefold, and almost all families now have access to continuous glucose monitoring. These tools help parents and caregivers feel more supported and confident as they care for their children at home.
Beyond medical care, Rady Children’s focuses on supporting the whole child and the whole family. Through a close partnership with Rady Children’s Population Health Department, families may access care navigation and resource support to help manage challenges inside and outside the clinic. This includes connecting to community resources, coordinating care and addressing everyday barriers that can make living with diabetes more difficult.
Building on this foundation, the program has added dedicated nurse manager outreach, giving families another trusted point of contact and helping ensure support between visits. Together, these efforts reflect Rady Children’s commitment to care that is personal, coordinated and family-centered, helping children living with diabetes thrive at home, at school and in their communities.
Early Detection: A New Way of Thinking About T1D
One of the most important innovations shaping the program today is a shift in how T1D is understood. Rather than beginning at the moment of diagnosis, research now shows the disease process often starts years before symptoms appear.
Long before blood sugar levels rise, the immune system can begin attacking the insulin-producing cells in the pancreas. This process can be detected through specific markers in the blood called autoantibodies. When two or more of these markers are present, it indicates that T1D will develop over time, changing the conversation from if to when.
This growing understanding has opened the door to new approaches in care, including earlier screening, closer monitoring and opportunities to intervene sooner. These advances allow families and care teams to prepare earlier, manage the condition proactively and reduce uncertainty along the way.
“We normally measure four specific T1D autoantibody markers in the blood,” Dr. Demeterco-Berggren says. “When a child has two or more detected and confirmed, it indicates the earliest stage of T1D. At that point, the lifetime risk of developing clinical diabetes is close to 100%.”
Identifying risk for T1D before symptoms appear can make a meaningful difference for children and their families. Early diagnosis allows care teams to monitor children closely and helps prevent diabetic ketoacidosis (DKA), a serious complication that can occur when diabetes goes unrecognized. DKA develops when the body does not have enough insulin to use glucose for energy, leading to a buildup of acids called ketones.
Early warning signs of T1D, such as increased thirst, frequent urination and weight loss, may be missed and progress to DKA. Early identification allows families and care teams to intervene before a medical emergency occurs. Despite advances in care, roughly half of children with Type 1 diabetes are still diagnosed after developing DKA and requiring emergency care.
“That experience is traumatic and often stays with families,” Dr. Demeterco-Berggren says. “When we monitor children we know are likely to develop T1D, we can help protect them from that crisis. It also allows families to begin diabetes care from a place of understanding and preparation, which makes a tremendous difference from the start.”
Early diagnosis also opens the door to treatments that can delay the need for insulin therapy for up to two years when T1D is detected early, before symptoms develop. While these treatments do not prevent diabetes, they give families valuable time to learn, plan and adjust with the support of an experienced care team.
Rady Children’s was among the first centers in the country to fully implement early detection screening, structured monitoring and medication infusion as part of clinical care. This integrated pathway allows children to move seamlessly from screening to monitoring to treatment and reflects Rady Children’s commitment to translating scientific advances into improved outcomes and experiences for families.
The Learning Curve
For families of children with diabetes, knowledge is power. At Rady Children’s, families receive structured, ongoing education and support designed to help them manage the condition effectively.
The multidisciplinary care team guides families through the basics of diabetes care, including daily routines and what to expect as they adjust to life with diabetes. Families learn how to monitor blood glucose, administer insulin, recognize and treat high and low blood sugar, understand how food and nutrition affect glucose levels and use tools such as continuous glucose monitors and insulin pumps. The goal is to help diabetes fit into a child’s life, not the other way around.
Rady Children’s continues to expand its commitment to early identification of T1D by strengthening education and outreach beyond the specialty clinic. The program is working closely with primary care physicians to emphasize the importance of offering T1D screening to individuals with a relative living with T1D and to those with a personal or family history of other autoimmune conditions. By equipping primary care teams with the knowledge and tools to identify risk earlier, more children and families can benefit from monitoring, early intervention and proactive support.
The long-term vision is to make T1D screening a routine part of pediatric care. While universal screening is not yet standard practice, these efforts represent an important step toward earlier detection, safer diagnoses and better outcomes.
Early in her career, Dr. Demeterco-Berggren worked as a pediatric endocrinologist in Brazil, where she saw firsthand how challenging diabetes care can be in communities with limited resources. That experience shaped her path and led her to the United States, where she pursued advanced training and completed PhD work focused on developmental therapeutics for T1D. Her work has been driven by a commitment to improving current treatments while advancing the next generation of therapies.
“Many of the advances we are seeing today focus on preventing or delaying the progression of T1D,” she says. “At the same time, we must remain focused on children who are already living with the condition and continue improving care and long-term outcomes.”
Though a cure does not yet exist, cell-based therapy initiatives are underway across the field. These efforts aim to preserve or restore insulin-producing cells and reduce the long-term burden of disease. Continued progress depends on sustained investment in basic science, well-designed clinical trials and implementation science so promising discoveries can be rigorously tested and equitably translated into real-world care.
“Progress is gaining momentum,” Dr. Demeterco-Berggren says. “With sustained investment and partnership, these advances can be accelerated and delivered more equitably, helping more children and families benefit from the next generation of therapies.”