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Staging autoimmune T1D

Recognizing presymptomatic autoimmune T1D at the early stages1–3

Autoimmune T1D can manifest from a combination of genetic and environmental factors leading to immune-mediated destruction of pancreatic beta cells and loss of their function.1
 
The autoimmune attack driving the progressive decline in ß-cell function in autoimmune T1D starts months to years before symptoms are seen.4 Stages 1 and 2 are presymptomatic and may go unseen until symptoms appear in Stage 3 and the individual is diagnosed with autoimmune T1D.1
 
Proactive screening in early autoimmune T1D helps to identify individuals who may be at risk.5,6

Autoimmune T1D happens in 3 stages

 

100% Functional ß-cell mass 0% Variable genetic and environmental risk for type 1 diabetes1 STAGE 1 PRESYMPTOMATIC ≥2 autoantibodies Normoglycemia1 Once someone develops two or more islet autoantibodies, their lifetime risk of developing Stage 3 autoimmune T1D approaches 100%1 STAGE 2 PRESYMPTOMATIC ≥2 autoantibodies Dysglycemia1 autoimmune T1D will inevitably progress from presymptomatic Stage 2 autoimmune T1D to Stage 3 autoimmune T1D1 STAGE 3 SYMPTOMATIC ≥2 autoantibodies Hyperglycemia1 Clinical T1D Up to 60% of individuals with autoimmune T1D are diagnosed in Stage 3 as a result of diabetic ketoacidosis (DKA). Even though they might not have had noticeable symptoms before DKA, the occurrence indicates that a large proportion of their ß-cells have already been destroyed.1,7

What’s the risk of symptomatic disease?1,2 Stage 1 5-year: ~44% 10-year: ~70% Lifetime: ~100% Stage 2 5-year: ~75% Lifetime: ~100%

What’s the risk of symptomatic disease?1,2

Reduce the risk of traumatic DKA8 Reduce the emotional burden of diagnosis9 Give parents and caregivers time to prepare for disease progression10

Early identification of individuals at risk for symptomatic Stage 3 autoimmune T1D may help:

  1. Insel RA, et al. Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care 2015;38(10): 1964–74.
  2. Sims EK, et al. Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective. Diabetes 2022;71:610–23.
  3. Besser REJ, et al. ISPAD clinical practice consensus guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes 2022;23(8):1175–87.
  4. Couper JJ, et al. ISPAD clinical practice consensus guidelines 2018: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes 2018;19(Suppl 27):20–7.
  5. Barker JM, et al. Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up. Diabetes Care 2004;27(6):1399–404.
  6. Elding Larsson H, et al. Reduced prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in young children participating in longitudinal follow-up. Diabetes Care 2011;34(11):2347–52.
  7. Beliard K, et al. Increased DKA at presentation among newly diagnosed type 1 diabetes patients with or without COVID-19: Data from a multi-site surveillance registry. J Diabetes 2021;13(3):270–2.
  8. Muñoz C, et al. Misdiagnosis and diabetic ketoacidosis at diagnosis of type 1 diabetes: Patient and caregiver perspectives. Clin Diabetes 2019;37(3):276–81.
  9. Juvenile Diabetes Research Foundation. Modeling the total economic value of novel type 1 diabetes (T1D) therapeutic concepts. January 2020. Available at: https://t1dfund.org/wp-content/uploads/2020/02/Health-Advances-T1D-Concept-Value-White-Paper-2020.pdf. Accessed February 2024.
  10. Scheiner G, et al. Screening for type 1 diabetes: Role of the diabetes care and education specialist. ADCES in Practice 2022;10(5):20–5.

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