This information is intended for US healthcare professionals.
Stages of T1D
Unravel the presymptomatic (Stage 1 and 2) story behind T1D
Once two or more autoantibodies develop and a patient begins experiencing dysglycemia, progression from Stage 2 T1D to Stage 3 T1D is inevitable. It’s not a matter of IF, but WHEN.
Type 1 diabetes mellitus is a chronic autoimmune-mediated disease that attacks pancreatic beta cells and is distinct from type 2 diabetes.1-3
Damage to beta cells begins months to years before the onset of Stage 3 T1D symptoms; those at increased risk may not be aware of the permanent beta-cell loss that is occurring.2
The decline in beta-cell function occurs in 3 distinct stages4,5
Stage 3 includes the “honeymoon phase,” a period following clinical diagnosis when the pancreas is still able to produce a sufficient amount of insulin to reduce exogenous insulin needs and aid blood glucose control.6
The presence of autoantibodies is a strong predictor of T1D6
In T1D, islet autoantibodies attach to healthy beta cells, targeting them for autoimmune-mediated destruction. Most patients who test positive for 2 or more autoantibodies will progress to Stage 3 T1D given enough time5,7:
Progression from Stage 1 (presymptomatic) to Stage 3 (clinical onset) occurs more rapidly the younger a patient is.5
Islet autoantibodies: glutamic acid decarboxylase antibody (GADA), insulin (IAA), IA-2 antigen (IA-2A), zinc transporter 8 (ZnT8A), and islet-cell Ab (ICA).3,8
Understanding the 3 stages of progression and the role of autoantibodies in T1D is critical to avoiding DKA at Stage 3 onset9,10
1. American Diabetes Association. Learn the genetics of diabetes. Accessed December 2, 2022. https://www.diabetes.org/diabetes/genetics-diabetes
2. Ziegler AG, Rewers M, Simell O, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. JAMA. 2013;309(23):2473-2479.
3. Scheiner G, Weiner S, Kruger DF, Pettus J. Screening for type 1 diabetes: role of the diabetes care and education specialist. ADCES Pract. September 2022:20-23.
4. Couper JJ, Haller MJ, Greenbaum CJ, et al. ISPAD Clinical Practice Consensus Guidelines 2018: stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2018;19(suppl 27):20-27.
5. Insel RA, Dunne JL, Atkinson MA, 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):1964-1974.
6. JDRF. Honeymoon Phase. Accessed December 8, 2022. https://www.jdrf/org/t1dresources/about/honeymoon-phase/
7. Xie Z, Chang C, Zhou Z. Molecular mechanisms in autoimmune type 1 diabetes: a critical review. Clin Rev Allergy Immunol. 2014;47(2):174-192.
8. Raab J, Haupt F, Scholz M, et al; Fr1da Study Group. Capillary blood islet autoantibody screening for identifying pre-type 1 diabetes in the general population: design and initial results of the Fr1da study. BMJ Open. 2016;6(5):e011144.
9. Barker JM, Goehrig SH, Barriga K, et al; DAISY study. Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up. Diabetes Care. 2004;27(6):1399-1404.
10. Elding Larsson H, Vehik K, Bell R, 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):2347-2353.