Updated criteria could open new possibilities for intervention before symptoms appear

JDRF is leading a pertinent discussion in the diabetes field about what defines a diagnosis of type 1 diabetes (T1D). At the 14th Annual Rachmiel Levine Diabetes and Obesity Symposium today, Richard Insel, M.D., JDRF’s chief scientific officer, reviewed evidence supporting the need to change the diagnostic criteria of T1D to recognize the fact that disease onset begins before its symptoms.
“Early, asymptomatic stages of type 1 diabetes may provide a window of opportunity in which we may be able to prevent symptomatic type 1 diabetes,” says Dr. Insel.

Most stories about being diagnosed with T1D begin with the onset of its symptoms; increased thirst, frequent urination, weight loss, and dizziness are a few of the symptoms most often experienced that lead to a doctor’s visit and ultimately a diagnosis. Once these symptoms arise, intervention –careful monitoring of blood sugars and insulin therapy – is life saving and has been shown to decrease health risks that often stem from prolonged, uncontrolled blood sugar levels. However, intervention only after the onset of symptoms misses a critically important opportunity to change the underlying course of the disease, potentially slowing, stopping, or reversing the disease before it becomes symptomatic and requires life-long insulin dependence.

For years, scientists have been studying the progression of T1D before symptoms manifest in order to explore the possibilities of even earlier intervention, and they now know more than ever before. One breakthrough in our understanding of the disease came from a decade-long study funded in part by JDRF, published in June 2013 in The Journal of the American Medical Association. The study followed children from infancy to determine the presence of islet autoantibodies, which indicate the activation of the autoimmune attack on insulin-producing beta cells in the pancreas that leads to T1D. The study revealed that the vast majority of children who had two or more islet autoantibodies invariably progressed to develop symptomatic T1D (i.e., required insulin).

Dr. Insel highlighted the need to engage the community of diabetes experts, including regulators and experts in industry, in a dialogue about redefining the criteria for a T1D diagnosis. Diagnosing a person with T1D during the asymptomatic phase of the disease would have a host of implications for research, development, and regulatory guidelines for clinical trials, as well as awareness of the disease. Through consensus building among all the relevant organizations, it may be possible to include new criteria in clinical guidelines in the not-too-distant future. JDRF is championing such a change because it could increase the focus on developing potential prevention therapies to change the course of the disease before symptomatic onset.