Setting the Stage for a Healthier Future

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Characterizing the early stages of T1D can facilitate early detection, potentially delaying the onset of symptoms

JDRF, in collaboration with other organizations and foundations involved in diabetes research, has designed a new system to characterize early stages of type 1 diabetes (T1D) before symptoms are apparent. Recognizing the early stages of T1D provides an opportunity to delay the onset of clinical symptoms and to prevent diabetic ketoacidosis (DKA) and hospitalization at the time of onset.

Creation of the new staging system was spurred by a growing body of research showing that T1D begins well before symptoms appear and progresses to symptomatic disease through distinct, sequential stages at a predictable rate. These stages are described in a joint scientific statement from JDRF, the Endocrine Society and the American Diabetes Association with endorsement by the American Association of Clinical Endocrinologists, The International Society for Pediatric and Adolescent Diabetes and The Leona M. and Harry B. Helmsley Charitable Trust. The statement was published in the online version of Diabetes Care on September 24, 2015. Richard Insel, M.D., JDRF Chief Scientific Officer, explained, “A decade of research and screening of people at risk for T1D has helped investigators better understand the onset and early stages of the disease, and that has allowed us to develop this new three-stage diagnostic approach. We believe this approach will help define a window of opportunity during which intervention may delay symptomatic disease.”

Currently, many people with T1D are not diagnosed until they develop symptoms such as excessive thirst, frequent urination, weight loss or fatigue. In some cases, diagnosis follows an acute episode of DKA, a life-threatening but reversible alteration of metabolism. In these cases, T1D is associated with greater mortality, longer hospitalization, poorer residual beta-cell function, worse metabolic control, higher insulin needs and adverse short-term effects on cognitive function.

But the new staging system can encourage earlier detection, which will improve outcomes for people with T1D. Evidence for this comes from several studies monitoring disease progression in people at high risk of developing T1D. Study participants were less likely to be hospitalized or to have symptoms including DKA at the time of diagnosis compared with nonparticipants. Children with T1D who are diagnosed as a result of their participation in monitoring studies may have better metabolic function at and shortly after diagnosis, which can improve diabetes management, decrease hypoglycemic episodes, delay the development of complications and decrease healthcare cost in the long term.

“Adoption of this staging system is a step toward developing approaches to prevent progression and onset of symptomatic disease,” said Dr. Insel.

Why It Matters

Recognizing the early stages of T1D provides an opportunity to delay the onset of clinical symptoms, prevent diabetic ketoacidosis and hospitalization at the time of onset, and improve outcomes for people with T1D.

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By Monica Harrington