title: Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association.
abstract: Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease.
authors.affiliation: JDRF, New York, NY rinsel@jdrf.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Insel
authors.affiliation: JDRF, New York, NY.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Dunne
authors.affiliation: UF Diabetes Institute, University of Florida, Gainesville, FL.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Atkinson
authors.affiliation: American Diabetes Association, Alexandria, VA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Chiang
authors.affiliation: Colorado School of Public Health, University of Colorado, Denver, CO.
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Gottlieb
authors.affiliation: Benaroya Research Institute at Virginia Mason, Seattle, WA.
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Greenbaum
authors.affiliation: Department of Immunobiology, Yale School of Medicine, New Haven, CT.
authors.forename: Kevan C
authors.initials: KC
authors.lastname: Herold
authors.affiliation: Department of Pediatrics, Pediatric Epidemiology Center, Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
authors.affiliation: Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Lernmark
authors.affiliation: American Diabetes Association, Alexandria, VA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Rewers
authors.affiliation: UF Diabetes Institute, University of Florida, Gainesville, FL.
authors.forename: Desmond A
authors.initials: DA
authors.lastname: Schatz
authors.affiliation: Diabetes Research Institute, University of Miami, Miami, FL.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Skyler
authors.affiliation: Diabetes Research Institute, University of Miami, Miami, FL.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Sosenko
authors.affiliation: Institute of Diabetes Research, Helmholtz Zentrum München, Munich and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.
authors.forename: Anette-G
authors.initials: AG
authors.lastname: Ziegler
mesh_terms: D001323:Autoantibodies / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology; D003922:Diabetes Mellitus, Type 1 / Q000145:classification / Q000175:diagnosis* / Q000276:immunology; D018450:Disease Progression; D042241:Early Diagnosis; D020022:Genetic Predisposition to Disease; D006801:Humans; D050417:Insulin-Secreting Cells / Q000276:immunology; D011236:Prediabetic State / Q000145:classification / Q000175:diagnosis / Q000276:immunology; D011446:Prospective Studies; D012955:Societies, Medical; D014481:United States
chemical_list: D001323:Autoantibodies