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A perspective on treating type 1 diabetes mellitus before insulin is needed

Tatovic, Danijela ORCID:, Narendran, Parth and Dayan, Colin M. ORCID: 2023. A perspective on treating type 1 diabetes mellitus before insulin is needed. Nature Reviews Endocrinology 19 , pp. 361-370. 10.1038/s41574-023-00816-5

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Type 1 diabetes mellitus (T1DM) is a progressive autoimmune disease that starts long before a clinical diagnosis is made. The American Diabetes Association recognizes three stages: stage 1 (normoglycaemic and positive for autoantibodies to β-cell antigens); stage 2 (asymptomatic with dysglycaemia); and stage 3, which is defined by glucose levels consistent with the definition of diabetes mellitus. This Perspective focuses on the management of the proportion of individuals with early stage 3 T1DM who do not immediately require insulin; a stage we propose should be termed stage 3a. To date, this period of non-insulin-dependent T1DM has been largely unrecognized. Importantly, it represents a window of opportunity for intervention, as remaining at this stage might delay the need for insulin by months or years. Extending the insulin-free period and/or avoiding unnecessary insulin therapy are important goals, as there is no risk of hypoglycaemia during this period and the adherence burden on patients of glycaemic monitoring and daily adjustments for diet and exercise is substantially reduced. Recognizing the pressing need for guidance on adequate management of children and adults with stage 3a T1DM, we present our perspective on the subject, which needs to be tested in formal and adequately powered clinical trials.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Additional Information: Author correction to this article found at: In the version of this article initially published, there was an error in the ‘Teplizumab (anti-CD3)’ box in Figure 3, where the description now reading “Binds to and inactivates CD3+ CD8+ T cells” appeared originally as “Binds to and depletes CD3+ T cells.” The correction has been made in the HTML and PDF versions of the article. © Springer Nature Limited 2023
Publisher: Nature Research
ISSN: 1759-5029
Date of First Compliant Deposit: 12 April 2023
Date of Acceptance: 17 February 2023
Last Modified: 17 Nov 2023 14:12

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