Staging in T1D

Learning Objectives

• Explain the different stages of T1D and the likelihood of progression for people with presymptomatic disease

Summary

This introduces the idea we have different stages of the disease. We have an autoimmune process that starts, but they don't end up needing insulin the following day.

Let's just walk our way through. Here's our two patients, Rosa and Tom, who are going through the stages. Stage 1 is when the autoimmune process has started. It's been triggered and triggered to the point where they're generating autoantibodies, in particular two or more antibodies. There is actually no way back at this point in time. We talk about a 0-1, in that situation it can disappear. Once they develop two or more antibodies, it's going to progress. And that's what we've learned over time.

Then there's a second stage here in which they now have lost more beta-cell function. They still have the antibodies, they've obviously still got the autoimmune process, but more and more beta cells have been lost to the point at which they're dysglycemic.

Once we get to the dysglycemic stage, it's getting very close and now there's over 75% chance that this is going to happen in the next 5 years, 75-80% it's going to happen very soon. And we believe that there's a lifetime risk of 100%. So, as I say, there's no way back at this point, it's progressing.

And then finally Stage 3, which is the point at which they tell me that they've got a problem. They're polydipsic, polyureic. They've lost so much beta-cell function; they cannot control their glucose to a point that they're in the diabetic range and they have symptoms.

I said it's going to progress, but it's going to go at different rates. And the reason we were less familiar with type 1 diabetes being diagnosed in adults is that the process is much slower in adults than it is in children, particularly under the age of 12 and particularly under the age of 5.

MAT-GLB-2407784-1.0 – 12/2024