JDRF, ADA redefine Type 1 diabetes framework to encourage early diagnosis, prevention

In an effort aimed at encouraging earlier diagnosis and even potentially prevention for Type 1 diabetes, the JDRF and the American Diabetes Association have published a new evaluation of the presymptomatic staging of Type 1 diabetes. Currently, Type 1 diabetes is typically not diagnosed until the patient in symptomatic--frequently in the emergency room with acute symptoms.

The JDRF and ADA point out that Type 1 diabetes is actually a progressive disease that can be diagnosed and potentially prevented before the full-blown disease develops. Specifically, they note that patients who test positive for multiple pancreatic islet autoantibodies are in Stage 1 and have progressed beyond glucose intolerance. What follows is a loss of functional beta cells, Stage 2, and, finally comes Stage 3 with symptomatic disease.

"We know Type 1 diabetes begins long before insulin dependence occurs, and the best time to halt the disease's progress is before the loss of insulin-producing pancreatic beta cells," said JDRF CSO Dr. Richard Insel in a statement. "Decades of research in at-risk individuals have provided the foundation for developing this new three-stage diagnostic approach, which we believe will help optimize the design of clinical trials to prevent symptomatic disease and more quickly evaluate interventions."

One-third of Type 1 diabetes patients currently are diagnosed in the emergency room when they present with an acute case of diabetic ketoacidosis (DKA). Other symptoms can also be a common diagnostic trigger including excessive thirst (polydipsia), frequent urination (polyuria), significant weight loss or fatigue. Type 1 diabetes was previously known as juvenile diabetes.

There have been breakthroughs in genetic analysis for Type 1 diabetes. About 50 genetic variants have been identified that increase Type 1 diabetes susceptibility. But an estimated 85% to 90% of newly diagnosed patients have no family history of the disease.

"Type 1 diabetes is diagnosed relatively late in the disease process. Pre-type 1 diabetes can be identified both in higher risk relatives and the lower risk general population," said Dr. Desmond Schatz, president-elect of medicine and science at American Diabetes Association.

He added, "Using a combination of genetic, immunologic and metabolic markers, distinct categorization of the natural history of the early disease process is now possible. This will facilitate the implementation of specific prevention studies at different stages of the disease process, each with their own distinct endpoints."

- here is the announcement
- and here is the full paper published in the ADA journal Diabetes Care

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