Department of Paediatrics and Department of Pathology, Immunology and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Paediatrics and Department of Pathology, Immunology and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL, USA.
Lancet Diabetes Endocrinol. 2024 Dec;12(12):924-933. doi: 10.1016/S2213-8587(24)00239-0.
In 2015, introduction of a disease staging system offered a framework for benchmarking progression to clinical type 1 diabetes. This model, based on islet autoantibodies (stage 1) and dysglycaemia (stage 2) before type 1 diabetes diagnosis (stage 3), has facilitated screening and identification of people at risk. Yet, there are many limitations to this model as the stages combine a very heterogeneous group of individuals; do not have high specificity for type 1 diabetes; can occur without persistence (ie, reversion to an earlier risk stage); and exclude age and other influential risk factors. The current staging system also infers that individuals at risk of type 1 diabetes progress linearly from stage 1 to stage 2 and subsequently stage 3, whereas such movements are often more complex. With the approval of teplizumab by the US Food and Drug Administration in 2022 to delay type 1 diabetes in people at stage 2, there is a need to refine the definition and accuracy of type 1 diabetes staging. Theoretically, we propose that a type 1 diabetes risk calculator should incorporate any available demographic, genetic, autoantibody, metabolic, and immune data that could be continuously updated. Additionally, we call to action for the field to increase the breadth of knowledge regarding type 1 diabetes risk in non-relatives, adults, and individuals from minority populations.
2015 年，引入疾病分期系统为临床 1 型糖尿病的进展提供了一个基准。该模型基于 1 型糖尿病诊断前的胰岛自身抗体（第 1 阶段）和糖代谢异常（第 2 阶段）（第 3 阶段），促进了风险人群的筛查和识别。然而，该模型存在许多局限性，因为这些阶段将非常异质的个体组合在一起；对 1 型糖尿病的特异性不高；可以在没有持续性（即恢复到更早的风险阶段）的情况下发生；并排除年龄和其他有影响的风险因素。目前的分期系统还推断，处于 1 型糖尿病风险中的个体从第 1 阶段线性进展到第 2 阶段，随后进展到第 3 阶段，而这种进展通常更为复杂。随着 2022 年美国食品和药物管理局批准 teplizumab 用于延缓 2 期人群的 1 型糖尿病，需要细化 1 型糖尿病分期的定义和准确性。从理论上讲，我们建议 1 型糖尿病风险计算器应纳入任何可用的人口统计学、遗传、自身抗体、代谢和免疫数据，并可不断更新。此外，我们呼吁该领域增加非亲属、成年人和少数族裔人群中 1 型糖尿病风险的知识广度。
