TrialNet identifies three progressive stages of Type 1 diabetes
For most people, the onset of Type 1 diabetes seems to begin suddenly, often resulting in a trip to the emergency department with life-threatening complications. The Hospital for Sick Children (SickKids) is a member of TrialNet, a worldwide leader in Type 1 diabetes prevention research and one of the prominent organizations working to change this scenario.
Diabetes Care, the JDRF, American Diabetes Association (ADA), and Endocrine Society recommend the adoption of a new Type 1 diabetes staging classification which is vital to understanding how Type 1 diabetes progresses. This recommendation is largely based on two decades of TrialNet research involving more than 150,000 relatives of people with Type 1 diabetes.
This condition can now be most accurately understood as a disease that progresses in three distinct stages.
“Our goals are to identify the disease at its earliest stage, delay progression, and ultimately prevent it,” explains Dr. Diane Wherrett, Staff Physician in the Division of Endocrinology at SickKids and Centre Director of the Type 1 diabetes TrialNet group. “We offer screening and clinical trials for every stage of Type 1 diabetes and close monitoring for disease progression.”
Stage One is the start of Type 1 diabetes. This occurs when individuals test positive for two or more diabetes-related autoantibodies. The immune system has already begun attacking the insulin-producing beta cells, although there are no symptoms and blood sugar remains normal.
Stage Two, like Stage One, includes individuals who have two or more diabetes-related autoantibodies, but now the blood sugar levels have become abnormal due to increasing loss of beta cells. However, there are still no symptoms. For both Stages One and Two, lifetime risk of developing Type 1 diabetes approaches at 100 per cent.
By Stage Three, clinical diagnosis has typically taken place because there is significant loss of beta cells and individuals generally show the common symptoms of Type 1 diabetes. This includes frequent urination, excessive thirst, weight loss, and fatigue.
According to TrialNet Chair Dr. Carla Greenbaum, “The identification of the pre-symptom stages of Type 1 diabetes can be compared to identification of high blood pressure as a predictor of heart attack and stroke. Before treatment for high blood pressure became commonplace, we were missing a key tool to prevent heart disease. Today, people can receive intervention long before they experience symptoms or significant complications. The same is now true for Type 1 diabetes.”
Clinical research supports the usefulness of diagnosing Type 1diabetes early—before beta cell loss advances to Stage Three. The earlier a diagnosis is made in the disease process, the sooner intervention can begin, and the more beta cells are likely to remain. More beta cells may lead to better outcomes regarding blood sugar control and reduction of long-term complications.
For people who participate in Type 1 diabetes prevention research like TrialNet, the risk of diabetic ketoacidosis (DKA) at diagnosis, which is a potentially life-threatening complication when the body produces high levels of acids called ketones, decreases from up to 30 per cent to less than four per cent.
Both the ADA and JDRF support the TrialNet study screening for people who have relatives with Type 1 diabetes because family members have a 15 times greater risk of being diagnosed than a person with no family history.
The study also allows children who do not test positive for diabetes-related autoantibodies to continue to get rescreened every year until the age of 18.