COMMENTARY

Preventing Type 1 Diabetes Before Symptoms Occur

Carla Greenbaum, MD; Mark Harmel, MPH

Disclosures

April 08, 2016

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We know a lot about the course of type 1 diabetes. We know that it starts long before people have clinical symptoms, and now we can actually define its different stages.

Stage 1 of type 1 diabetes is when you have two or more autoantibodies present. This is before blood glucose is abnormal and precedes symptoms, but the disease has actually started. Stage 2 is when you have multiple autoantibodies and blood glucose is slightly abnormal. However, at this stage, people don't have any symptoms either. It's only at stage 3 of type 1 diabetes that those clinical symptoms occur.

Why is it important that people know about the stages of diabetes? We're trying to intervene in this process and slow or prevent progression from one stage to another.

First of all, one of the things that we've learned is that family members are at increased risk for type 1 diabetes. They have about a 15-fold increased risk.[1] This is a group to check for these autoantibodies to see if they're going to be developing disease.

Another thing we've learned is that even though type 1 diabetes is a disease that affects both children and adults, we know that the disease course is quite different. For example, children who have multiple autoantibodies progress to develop disease much more quickly than an adult who has multiple autoantibodies. Even after clinical diagnosis, children will lose remaining insulin production or beta-cell function long before an adult who is diagnosed with type 1 diabetes.

In both cases, our aim is to slow or prevent this progression. It may be particularly important to identify children, but we need to understand that this disease can occur at any age. The important thing to remember is that family members are at increased risk for diabetes, and it's your responsibility to let them know that they are at risk and that they can be tested as part of TrialNet.[2] [Editor's note: Clinicians can refer family members of patients with type 1 diabetes on the TrialNet site, where they can complete an online screening or contact the program for more information.]

It's also important to know that we have made progress. We have several therapies that can interfere with the disease process, and we need to continue to study this so that we can find new therapies for people with diabetes.

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