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Time to reframe the disease staging system for type 1 diabetes.
Laura M Jacobsen1, Mark A Atkinson1, Jay M Sosenko2
1Department of Paediatrics and Department of Pathology, Immunology and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL, USA.
The Lancet. Diabetes & Endocrinology
|November 28, 2024
Summary
The current type 1 diabetes staging system needs refinement due to its limitations. A new risk calculator should integrate diverse data for more accurate predictions and personalized screening.
Area of Science:
- Immunology
- Endocrinology
- Clinical Research
Background:
- A 2015 staging system for type 1 diabetes (T1D) uses autoantibodies and dysglycaemia to identify at-risk individuals.
- This system has facilitated screening but has limitations including heterogeneity, low specificity, and exclusion of key risk factors like age.
Purpose of the Study:
- To address the limitations of the current T1D staging system.
- To propose a refined approach for T1D risk assessment and staging.
Main Methods:
- The study proposes a theoretical framework for an improved T1D risk calculator.
- This calculator would continuously integrate demographic, genetic, autoantibody, metabolic, and immune data.
Main Results:
- Current staging is limited by heterogeneity, lack of specificity, potential for reversion, and exclusion of crucial risk factors.
- Linear progression assumption is often inaccurate for T1D development.
Conclusions:
- There is a critical need to refine T1D staging accuracy, especially with new therapies like teplizumab.
- A comprehensive, continuously updated risk calculator is proposed to improve T1D risk prediction.
- Further research is needed on T1D risk in non-relatives, adults, and minority populations.
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