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Review
. 2015 Oct;38(10):1964-74.
doi: 10.2337/dc15-1419.

Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A Insel  1 , Jessica L Dunne  2 , Mark A Atkinson  3 , Jane L Chiang  4 , Dana Dabelea  5 , Peter A Gottlieb  6 , Carla J Greenbaum  7 , Kevan C Herold  8 , Jeffrey P Krischer  9 , Åke Lernmark  10 , Robert E Ratner  4 , Marian J Rewers  6 , Desmond A Schatz  3 , Jay S Skyler  11 , Jay M Sosenko  11 , Anette-G Ziegler  12
Affiliations
Review

Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A Insel et al. Diabetes Care. 2015 Oct.

Abstract

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease.

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Figures

Figure 1
Figure 1
Early stages of type 1 diabetes.
Figure 2
Figure 2
Progression to symptomatic stage 3 type 1 diabetes from time of islet autoantibody seroconversion in stage 1 at-risk children with multiple islet autoantibodies (7).
Figure 3
Figure 3
Probability of progression to stage 3 symptomatic type 1 diabetes stratified for number of islet autoantibodies from birth (7).
Figure 4
Figure 4
Probability of progression in islet autoantibody-positive relatives of individuals with type 1 diabetes stratified for number of autoantibodies (8).
Figure 5
Figure 5
Probability of progression from dysglycemia stage 2 in DPT-1. IGT, impaired glucose tolerance (unpublished data from DPT-1 [4,32]).
See this image and copyright information in PMC

References

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