title: Rebranding asymptomatic type 1 diabetes: the case for autoimmune beta cell disorder as a pathological and diagnostic entity.
abstract: The asymptomatic phase of type 1 diabetes is recognised by the presence of beta cell autoantibodies in the absence of hyperglycaemia. We propose that an accurate description of this stage is provided by the name 'Autoimmune Beta Cell Disorder' (ABCD). Specifically, we suggest that this nomenclature and diagnosis will, in a proactive manner, shift the paradigm towards type 1 diabetes being first and foremost an immune-mediated disease and only later a metabolic disease, presaging more active therapeutic intervention in the asymptomatic stage of disease, before end-stage beta cell failure. Furthermore, we argue that accepting ABCD as a diagnosis will be critical in order to accelerate pharmaceutical, academic and public activities leading to clinical trials that could reverse beta cell autoimmunity and halt progression to symptomatic insulin-requiring type 1 diabetes. We recognize that there are both opportunities and challenges in the implementation of the ABCD concept but hope that the notion of 'asymptomatic autoimmune disease' as a disorder will be widely discussed and eventually accepted.
authors: DFG Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 105, 01307, Dresden, Germany. ezio.bonifacio@crt-dresden.de.|Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Technische Universität Dresden, Dresden, Germany. ezio.bonifacio@crt-dresden.de.
authors: Ezio
authors: E
authors: Bonifacio
authors: Clinical and Experimental Endocrinology, University Hospital of Leuven, Leuven, Belgium.
authors: Chantal
authors: C
authors: Mathieu
authors: Benaroya Research Institute at Virginia Mason, The University of Washington School of Medicine, Seattle, WA, USA.
authors: Gerald T
authors: GT
authors: Nepom
authors: Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.|Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.
authors: Anette-G
authors: AG
authors: Ziegler
authors: T1D Exchange, Boston, MA, USA.
authors: Henry
authors: H
authors: Anhalt
authors: Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA.
authors: Michael J
authors: MJ
authors: Haller
authors: Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.|Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.
authors: Leonard C
authors: LC
authors: Harrison
authors: University of California, San Francisco Diabetes Center, San Francisco, CA, USA.
authors: Matthias
authors: M
authors: Hebrok
authors: McNair Medical Institute, Pediatric Diabetes and Endocrinology, Baylor College Medical Center, Houston, TX, USA.
authors: Jake A
authors: JA
authors: Kushner
authors: Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors: Jill M
authors: JM
authors: Norris
authors: Department of Immunobiology, King's College London Faculty of Life Sciences & Medicine, London, UK.|National Institute of Health Research Biomedical Research Centre at Guy's and St Thomas' Hospitals and King's College London, London, UK.
authors: Mark
authors: M
authors: Peakman
authors: Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University School of Medicine, Nashville, TN, USA.|VA Tennessee Valley Healthcare System, Nashville, TN, USA.
authors: Alvin C
authors: AC
authors: Powers
authors: JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK.
authors: John A
authors: JA
authors: Todd
authors: Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
authors: Mark A
authors: MA
authors: Atkinson
mesh_terms: D015551:Autoimmunity / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology; D006801:Humans; D050417:Insulin-Secreting Cells / Q000276:immunology / Q000473:pathology*
keywords: Autoimmunity; Beta cell; Diabetes; Disease classification