JDRF International in collaboration with the American Diabetes Association (ADA) has published a new classification system for identifying and defining the early, pre-clinical stages of type 1 diabetes (T1D).
Currently, T1D is not diagnosed until the onset of acute symptoms such as rapid and unexpected weight loss and unquenchable thirst. Diagnosis often occurs in the hospital emergency room, yet long before these symptoms appear, the development of T1D slowly progresses undetected.
The pre-clinical staging model published by JDRF and ADA is based on the concept that T1D begins long before classic symptoms appear, and progresses through three distinct stages:
Stage 1: Multiple pancreatic islet autoantibodies present in the body
Stage 2: Glucose intolerance or dysglycaemia due to dysfunctional pancreatic beta cells
Each of these stages has the potential to be targeted with different strategies to prevent or slow the progression of the disease. Defining the stages clearly within this framework will aid in the design and development of targeted therapies, and improve the efficiency of clinical trials.
Researchers will now be able to measure progression from one stage to the next as an end-point in trials rather than waiting for the onset of symptoms. This means that researchers will be able to see whether a drug is effective or not in a much shorter period of time, accelerating the progress of promising therapies and preventing resources from being wasted on those that are ineffective.
“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 Chief Scientific Officer 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.”
8 YEAR OLD TWINS FROM CANBERRA, HANNAH AND OLIVIA, WERE DIAGNOSED WITH T1D 4½ YEARS APART
Olivia was tested for T1D antibodies when her twin sister Hannah was diagnosed with T1D at 2 years of age. She tested positive for 2 antibodies and their mum Adrienne was told by doctors that Olivia was also likely to get T1D. Four and a half years later, Olivia was diagnosed with T1D just like her twin sister Hannah. With a greater understanding of the pre-symptomatic stages of T1D in those at risk of developing the condition, researchers will be able to test targeted prevention therapies that may one day stop the disease from progressing in people like Hannah and Olivia.