Delaying the Onset of Type 1 Diabetes Through Early Intervention - Episode 3

T1D Staging and Classification

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Expert endocrinologists review the importance of staging and classifying T1D, highlighting dysglycemia.

Steve Edelman, MD: Let’s talk about staging and classification. The earlier we introduce that, the better it will be. We can refer back to the stages as we go through.

Egils K. Bogdanovics, MD: In the past, the presentation was explosive. When the 3 of us were diagnosed, it was probably DKA [diabetic ketoacidosis], and we were really sick. But there’s a long presymptomatic phase. Around 2015, the JDRF, ADA [American Diabetes Association], and the Endocrine Society came up with staging to formalize it, breaking it down into 3 stages. Stage I is the presence of 2 or more autoantibodies. At that point you’ve got all your beta cells, and you’re functioning perfectly well in your glycemic status. In stage II, there’s some progressive loss of beta cell function and dysglycemia. That’s a funny word because it’s not hyperglycemia; it’s dysglycemia. Mainly, you flunked an oral glucose tolerance test [OGTT] in the IFG [impaired fasting glucose] or IGT [impaired glucose tolerance] range, but it’s not quite diabetes.

At that point, you probably have postprandial hyperglycemia, so a fasting glucose might not be helpful, but OGTT will put you in that stage. Maybe in the future we’ll be using CGM [continuous glucose monitoring] to diagnose those patients as well. You’ve got 100% lifetime risk of developing type 1 diabetes if you’re in stage I or stage II. But at stage I, your 5-year risk is about 44%. At stage II, it goes up to 75%. This is an important group of patients to stage and follow. By stage III, you’re hyperglycemic and you’ve got overt diabetes. The progression is a little different depending on the age. In the young, the progression is a lot faster than it is in older patients, adults diagnosed with type 1 diabetes.

Steve Edelman, MD: That might have implications when we talk more about screening. Schafer, [do you have] any comments about the different stages? They tried to make it simple, and you did a good job explaining it. It may get more complicated as time goes on.

Schafer Boeder, MD:Dysglycemia is a funny term. Maybe at some point we’ll be able to clarify what that means and how to diagnose that. We’ll talk more about the autoantibodies that we’re specifically looking at, but we must understand how to utilize those and how different numbers of positive antibodies affect your risk, including different titers. There’s a lot of confusion in that area but thankfully a lot of interest as well, and we’re starting to learn a lot more about it.

Transcript edited for clarity