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Can autoimmune type 1 diabetes be detected years before symptom onset?

Autoimmune type 1 diabetes (T1D) is a progressive disease in which the decline in beta cell function usually begins months or sometimes years before clinical symptoms are observed.1–3 You can identify such patients at risk of developing autoimmune T1D before clinical symptoms are noticed by you or your patient.3

Key Takeaway

Is the pathogenesis of autoimmune T1D poorly understood?

The pathogenesis of autoimmune T1D involves a complex interaction between the beta cells and immune system.1 It begins when the autoreactive T cells recognize and destroy the pancreatic beta cells. This leads to a critical decline in insulin levels, which in turn causes ineffective control of blood glucose levels. Eventually, the remaining beta cells become insufficient to maintain normal blood glucose reducing insulin secretion and leading to autoimmune T1D.2

Lately, many autoantigens responsible for triggering immune-mediated destruction of beta cells have been identified; however, the triggering factors for this autoimmune response remain poorly understood.2,3  

Please hit the play button below to understand one of the potential mechanisms behind the triggering of the autoimmune response

A potential mechanism for triggering autoimmune response2

Does the onset of autoimmune T1D begin long before symptoms appear?

In general, autoimmune T1D is a disease continuum that progresses sequentially through identifiable stages before symptoms appear. The rate of progression of T1D from the stage of autoimmune response to symptomatic disease varies among individuals and may take from few months to decades.3

Genetic susceptibility and genetic risk detection of autoimmune T1D

It is noteworthy that people living with other associated autoimmune diseases, such as celiac disease and autoimmune thyroid disease, are at an increased risk of developing autoimmune T1D than the general population.4 Shared genetic risk factors and immune system dysregulation are potentially implicated both in polyautoimmunity (occurrence of ≥2 autoimmune diseases in a single patient) and family autoimmunity (presence of ≥2 autoimmune diseases in members of a nuclear family) among individuals with autoimmune T1D.5

Currently, first- or second-degree relatives of individuals with autoimmune T1D or pediatric population are being screened for increased risk of developing autoimmune T1D in the research setting.3

For additional information on common genetic risk factors linked to autoimmune T1D, please read this article.

Check for autoimmune type 1 diabetes!

Check for autoimmune type 1 diabetes!

Does your patient have an existing autoimmune condition?

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What are the stages of autoimmune T1D?

The Breakthrough T1D (formerly JDRF), the Endocrine Society, and the American Diabetes Association (ADA) have proposed three distinct stages of development and progression of autoimmune T1D, starting with the stage of activation of autoimmune response against the beta cells through symptomatic T1D.3

Progressive destruction of beta-cell function through different stages of autoimmune T1D3,6

The below figure illustrates the three distinct stages of autoimmune T1D.

Stages-aT1D

Can autoimmune T1D be identified before symptom onset?

Conventionally, autoimmune T1D is diagnosed after onset of clinical symptoms. However, latest research evidence on pathophysiological mechanisms leading to development and progression of T1D enable us to identify autoimmune T1D in its presymptomatic stages (Stage 1 and Stage 2 as described above).3

Early detection of presymptomatic stages through screening for autoantibodies provides us with an opportunity to intervene, to delay and ultimately prevent the symptomatic manifestation of autoimmune T1D.3

Please click on the play button below to explore the potential benefits!

Early identification of individuals at risk of autoimmune T1D has a range of potential benefits6,9–11

Early detection of autoimmune T1D is possible. You can identify patients at risk months to years before clinical symptoms appear!1-3

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