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Staging Presymptomatic Type 1 Diabetes

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

N2 - Insights fromprospective, 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 b-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of b-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. AB - Insights fromprospective, 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 b-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of b-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 sympto Continue reading >>

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association.

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association.

Diabetes Care. 2015 Oct;38(10):1964-74. doi: 10.2337/dc15-1419. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. UF Diabetes Institute, University of Florida, Gainesville, FL. American Diabetes Association, Alexandria, VA. Colorado School of Public Health, University of Colorado, Denver, CO. Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO. Benaroya Research Institute at Virginia Mason, Seattle, WA. Department of Immunobiology, Yale School of Medicine, New Haven, CT. Department of Pediatrics, Pediatric Epidemiology Center, Morsani College of Medicine, University of South Florida, Tampa, FL. Lund University/Clinical Research Centre, Skne University Hospital, Malm, Sweden. Diabetes Research Institute, University of Miami, Miami, FL. Institute of Diabetes Research, Helmholtz Zentrum Mnchen, Munich and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universitt Mnchen, Neuherberg, Germany. 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 -cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of -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 Continue reading >>

Type 1 Diabetes: Disease Stratification

Type 1 Diabetes: Disease Stratification

Type 1 diabetes, a disorder characterized by immune-mediated loss of functional pancreatic beta cells, is a disease continuum with specific presymptomatic stages with defined risk of progression to symptomatic disease. Prognostic biomarkers have been developed for disease staging and for stratification of subjects that address the heterogeneity in rate of disease progression. Using biomarkers for stratification of subjects at different stages of type 1 diabetes will enable smaller and shorter intervention clinical trials with greater effect size. Addressing the heterogeneity of the disease will allow precision medicine-based approaches to prevention and interception of presymptomatic stages of disease and treatment and cure of symptomatic disease. 2017 The Author(s) Published by S. Karger AG, Basel Type 1 diabetes (T1D) is a chronic, immune-mediated disease associated with destruction of the insulin-producing beta cells of the islets of the pancreas [ 1 ]. Approximately 40-50% of the risk of disease arises from genetics with the remaining risk arising from poorly defined environmental etiologies. The class I and II human leukocyte antigen (HLA) genes contribute about half of the genetic risk of disease with about 40-50 non-HLA genes accounting for the remainder of genetic risk [ 2 , 3 , 4 ]. The most prominent associated HLA genes are HLA class II haplotypes DRB1*0301-DQB1*0201 (DR3-DQ2) and DRB1*0401-DQB1*0302 (DR4-DQ8) with the highest risk occurring in the heterozygous DR3/4 genotype. Non-HLA genes include INS, CTLA4, PTPN22, and IL2RA in addition to multiple non-HLA SNPs that have been mapped to DNA regulatory sequences of immune cells [ 4 , 5 ]. Several non-HLA susceptibility genes are expressed in human islets, and cytokines can alter their expression in the isle Continue reading >>

The Stages Of Type 1 Diabetes (it Starts Earlier Than We Thought)

The Stages Of Type 1 Diabetes (it Starts Earlier Than We Thought)

My daughter Bisi was diagnosed with type 1 diabetes three years ago at the age of six. The first night after she was diagnosed, once she finally fell asleep in her hospital bed, tossing and turning despite the IV in her arm, I remember standing outside in the hall with my husband and a couple of medical residents, talking with them about her diagnosis. “Could this have been coming on for a while?” we asked them. I described how for a couple of years, Bisi had been almost unbearably cranky when she was hungry—to the point where I’d asked her pediatrician more than once if something might be wrong. No, the residents told us. Type 1 diabetes comes on very suddenly, in a matter of weeks, as the body’s beta cells suddenly die out under attack from the immune system. Every doctor or nurse we spoke with during the three days in the hospital (except for one, who said that our instincts were probably right), echoed what the two residents, fresh from medical school, told us. But it turns out they were wrong. JDRF and the American Diabetes Association, supported by other organizations in the field, recently put forth a new staging system for type 1 diabetes, where full-blown disease, like what landed Bisi in the hospital, is characterized as stage 3, part of an extended auto-immune process that often starts in infancy. This fall, Dr. Richard Insel, JDRF’s Chief Scientific Officer, explained the classification system to a group of reporters, talking through the importance of early diagnosis, and the hope that diagnosing the disease at an earlier stage could lead to breakthroughs in stopping the beta-cell destruction process—essentially, stopping the disease before it starts. Insel explained that stage 1 is when people test positive for multiple pancreatic islet auto-a Continue reading >>

New Staging Approach Developed For Type 1 Diabetes

New Staging Approach Developed For Type 1 Diabetes

New Staging Approach Developed for Type 1 Diabetes A new classification approach for the preclinical staging of type 1 diabetes has been developed by the Juvenile Diabetes Research Foundation (JDRF) and the American Diabetes Association (ADA). The model, based on the concept that there is a progressive process leading up to symptomatic type 1 diabetes, "will aid the development of therapies and the design of clinical trials to prevent symptomatic disease and promote precision medicine," according to a joint JDRF/ADA statement published in the October issue of Diabetes Care. While JDRF and ADA are not advising clinical use of the model for screening at this time, "the staging approach will provide a framework to help inform benefit/risk evaluation in the regulatory, reimbursement, and clinical-care settings," JDRF chief scientific officer Richard A Insel, MD, and colleagues write in the paper. Stage 1: Autoimmunity/normoglycemia/presymptomatic type 1 diabetes.Individuals in this stage have two or more type 1 diabetesassociated islet autoantibodies but are still normoglycemic. In one study of children who reached this stage, the risks for developing symptomatic disease were 44% at 5 years and 70% at 10 years, with a lifetime risk of nearly 100%. Stage 2: Autoimmunity/dysglycemia/presymptomatic type 1 diabetes.These individuals have two or more islet autoantibodies and have lost enough beta cells to become glucose intolerant. The 5-year risk for frank type 1 diabetes at this stage is approximately 75% at 5 years and nearly 100% thereafter. Stage 3: Symptomatic type 1 diabetes. The individual demonstrates typical clinical symptoms and signs of diabetes, including polyuria, polydipsia, weight loss, fatigue, and diabetic ketoacidosis (DKA). In natural-history studies, short- Continue reading >>

Identifying Stages Of Type 1 Diabetes Could Help With Intervention

Identifying Stages Of Type 1 Diabetes Could Help With Intervention

Type 1 diabetes onset is sudden and unexpected. The disease is typically diagnosed during a trip to the emergency room for treatment of dangerously high blood sugars. By then, beta cells have been almost completely destroyed by the immune system. The American Diabetes Association (ADA) and the JDRF want to be able to detect type 1 diabetes earlier in its progression, before the immune system can damage the insulin-secreting cells, and hopefully intervene to prevent the development of the damaging symptoms of type 1 diabetes. “The overall goal is to try to develop approaches that can preserve residual beta cell function, but that means we have to identify risk for type 1 diabetes before substantial amounts of beta cells have been irreversibly destroyed by the immune system. If this earlier stage can be identified with certainty, there can be interventions earlier in the process when there are greater amounts of functioning beta cells to preserve, rather than at the current stage of diagnosis when the overwhelming majority have been destroyed or damaged”, says Lori Laffel, M.D., M.P.H., Chief, Pediatric, Adolescent, and Young Adult Section at Joslin Diabetes Center. The ADA and the JDRF recently released a suggested three-stage classification system for diagnosing type 1 diabetes and clarifying risk. Stage 1 indicates the presence of some autoimmunity. Stage 2 happens when the autoimmunity starts to affect blood sugar levels. Stage 3 is the state at which most people are currently diagnosed, involving symptoms such as excessive thirst, hunger and urination. Investigators hope to use this staging system as a research roadmap, to help investigators better plan intervention strategies. Catching the disease at an early stage requires screening, before individuals start sh Continue reading >>

Jdrf And The American Diabetes Association, In Collaboration With Multiple Diabetes Organizations Publish New Classification And Staging Approach For Presymptomatic Type 1

Jdrf And The American Diabetes Association, In Collaboration With Multiple Diabetes Organizations Publish New Classification And Staging Approach For Presymptomatic Type 1

JDRF and the American Diabetes Association, in Collaboration with Multiple Diabetes Organizations Publish New Classification and Staging Approach for Presymptomatic Type 1 Diabetes Organizations Endorse Concept that Autoimmune Disease Begins Long Before Symptoms Occur and Progresses through Distinct Stages, which Provide a Window of Opportunity to Intervene and Prevent Symptomatic Disease JDRF and the American Diabetes Association (Association), announced today that a new classification approach for staging T1D in its earliest presymptomatic stages would be published in the September 24th online version of Diabetes Care. JDRF convened a group of leading diabetes research and clinical organizations to develop the staging approach, which was published as a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association and endorsed by the American Association of Clinical Endocrinologists, the International Society for Pediatric and Adolescent Diabetes, and The Leona M. and Harry B. Helmsley Charitable Trust. The pre-clinical staging model embraces the concept that T1D begins prior to symptomatic disease and then progresses to a point of certainty for insulin replacement. The staging approach will aid the development of therapies and the design of clinical trials to prevent symptomatic disease and promote precision medicine. Finally, the staging approach will provide a framework to help inform benefit/risk evaluation in the regulatory, reimbursement, and clinical care settings. "We know type 1 diabetes begins long before insulin dependence occurs, and the best time to halt the disease's progress is before the loss of insulin-producing pancreatic beta cells," said JDRF's Chief Scientific Officer, Richard Insel, M.D. "Decades of research in at-ris Continue reading >>

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society IPH presents results of a study of the lifetime cost of childhood obesity on the island of Ireland at the Summer Scientific Meeting 2018 The Faculty of Public Health's Annual Summer Scientific Meeting was held on 30th & 31st of May 2018in Dublin.Professor Kevin P. Balanda from the IPH presented the results from the 'Lifetime financial costs of childhood obesity/overweight in Ireland and Northern Ireland'. The JANPA/safefood project estimated that the obesity/overweight in the island's 2015 childhood population was associated with lifetime excess financial costs of 7.1 (in 2015 values). Direct health care costs accounted for approximately 25% of this total costs. The biggest cost category was lost productivity due to premature death that accounted for approximately 60% of total excess lifetime costs on the island. The study highlights gender differences and North/South differences in the magnitude of the cost categories. IPH contributes to the JANPA Skills Building Workshopto ECO2018 The ECO2018 Congress on Obesity was held from 23rd to 26th of May 2018in Vienna, Austria.Professor Kevin P. Balanda from the IPH contributed a session to the JANPA Workshop. The brief session looked atmobilising data and research to estimate the lifetime costs of childhood obesityusing the JANPA costing model. Itoutlined thedata and research required, describedsome of the challenges and gave tips for overcoming thesechallenges. It ended with a brief overview of the opportunities that exist for countries in conducting such study in their country. Co Continue reading >>

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association.

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association.

Home Research Outputs Staging Presymptomatic Type 1 Diabetes: A Scientific Stateme... Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association. Research output: Contribution to journal Article 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 -cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of -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. Benaroya Research Institute at Virginia Mason Continue reading >>

New Insights Into The Progression Of Type 1 Diabetes

New Insights Into The Progression Of Type 1 Diabetes

If you have Type 1 diabetes or know someone who does, you’re likely aware that this type of diabetes is an autoimmune disorder that results in the destruction of the beta cells (the cells that make insulin) in the pancreas. Having Type 1 diabetes means having to take lifelong insulin injections, and people who are diagnosed with this condition must start on insulin right away. Type 1 diabetes progresses Type 2 diabetes, the “other” type of diabetes, is a whole different ball of wax. This type of diabetes partly stems from insulin resistance, meaning that the pancreas produces insulin but the body has a hard time using it. Type 2 diabetes is often described as being “progressive”: caught in the early stages, for example, it’s possible to manage it through healthy eating, weight loss (if necessary), and physical activity. But over time, many people require the help of medication, often in the form of diabetes pills, and then, perhaps, noninsulin injectable meds. Eventually, insulin injections may be needed. In the case of Type 1 diabetes, researchers now believe that this disease also progresses at predictable rates and stages before a person develops signs and symptoms. The discovery of these stages is a big deal, as it will enable researchers to find ways to intervene to delay and hopefully prevent progression to the onset of symptoms and lifelong insulin dependence. Stages of Type 1 diabetes The discovery of the various stages leading up to symptomatic Type 1 diabetes are outlined in the October 2015 issue of the journal Diabetes Care. The paper is entitled “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” Here’s a closer look at the crux of this paper. Stage 1: Auto Continue reading >>

New Staging System For Presymptomatic Type 1 Diabetes

New Staging System For Presymptomatic Type 1 Diabetes

New Staging System for Presymptomatic Type 1 Diabetes Released by JDRF, the Endocrine Society, and the American Diabetes Association Commentary by Richard Insel MD, Desmond Schatz MD, and Kevan Herold MD A new approach for staging T1D in its earliest presymptomatic stages was released by the JDRF, the Endocrine Society, and the American Diabetes Association. The organizations endorse the concept that autoimmune disease precedes the onset of symptoms and progresses through distinct stages, as reported in the October issue of Diabetes Care. Stage 1: individuals who are normoglycemic but test positive for 2 or more type 1 diabetesassociated islet autoantibodies. Stage 2: individuals with 2 or more islet autoantibodies who have developed glucose intolerance or dysglycemia, from loss of functional -cell mass. Stage 3: individuals who have symptoms of type 1 diabetes, such as polyuria, polydipsia, weight loss, fatigue, and diabetic ketoacidosis. While the rate of progression between stages is variable among individuals, the risk can be defined, which may facilitate clinical trials that aim to preserve functional insulin-producing beta cells, according to the associations. In addition, while approximately 50 genetic variants that increase susceptibility to T1D have been discovered; 85% to 90% of individuals newly diagnosed with T1D have no history of T1D among their relatives, the associations noted. We know type 1 diabetes begins long before insulin dependence occurs, and the best time to halt the diseases progress is before the loss of insulin-producing pancreatic beta cells, Chief Scientific Officer of JDRF Richard Insel, MD, said in a statement to the press. Decades of research in at-risk individuals have provided the foundation for developing this new 3-stage diagnostic Continue reading >>

Staging Presymptomatic Type 1 Diabetes

Staging Presymptomatic Type 1 Diabetes

Progression through 3 identifiable phases noted The Juvenile Diabetes Research Foundation, the Endocrine Society, and the American Diabetes Association have published a statement entitled, Staging Presymptomatic Type 1 Diabetes. It draws on data and insights from prospective and longitudinal studies of those at risk of developing type 1 diabetes. The authors note that type 1 diabetes is a continuum that progresses through identifiable stages before disease onset. Specifically: Stage 1 is marked by the presence of beta-cell autoimmunity, manifested by the presence of 2 or more islet autoantibodies with normoglycemia. It is presymptomatic at this stage. Stage 2 also has the presence of beta-cell autoimmunity, but with dysglycemia. It is presymptomatic at this stage, as well. Stage 3 marks the onset of symptomatic disease. The authors explained that adopting such system allows for a staging classification for type 1 diabetes that will, among other things, facilitate the development of targeted therapies and promote precision medicine. Citation: Insel R, Dunne J, Atkinson M, et al. Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care 2015;38:19641974. Continue reading >>

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Diabetes Care 2015;38:19641974 |DOI: 10.2337/dc15-1419 The Adoption of the Staging Classication System Is Endorsed by the American Association of Clinical Endocrinologists, the International Society for Pediatric and Adolescent Diabetes, and The Leona M. and Harry B. Helmsley Charitable Trust 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 identi- able stages prior to the onset of symptoms. Stage 1 is dened as the presence of b-cell autoimmunity as evidenced by the presence of two or more islet autoanti- bodies with normoglycemia and is presymptomatic, stage 2 as the presence of b-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classication provides a standardized taxonomy for type 1 diabetes and will aid the development of ther- apies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benet/risk ratio that will impact regulatory approval, reimbursement, and adoption of interven- tions in the early stages of type 1 diabetes to prevent symptomatic disease. Type 1 diabetes is a chronic autoimmune disease with both genetic and environ- mental contributions that results over time in an immune-mediated loss of func- tional pancreatic b-cell mass, leading to symptomatic diabetes and lifelong insulin dependence (13). The disorder represents a disease continuum that begins prior to its symptomatic manifestations. The risk of developing symptomatic type 1 diabetes can be identied and quantied, the disease can be characterized into well- Continue reading >>

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement Of Jdrf, The Endocrine Society, And The American Diabetes Association

Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association Insel, R.A.; Dunne, J.L.; Atkinson, M.A.; Chiang, J.L.; Dabelea, D.; Gottlieb, P.A.; Greenbaum, C.J.; Herold, K.C.; Krischer, J.P.; Lernmark, ke.; Ratner, R.E.; Rewers, M.J.; Schatz, D.A.; Skyler, J.S.; Sosenko, J.M.; Ziegler, A-G. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association 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 -cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of -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. Continue reading >>

New Classification And Staging Approach For Presymptomatic Type 1

New Classification And Staging Approach For Presymptomatic Type 1

New Classification and Staging Approach for Presymptomatic Type 1 New Classification and Staging Approach for Presymptomatic Type 1 New Classification and Staging Approach for Presymptomatic Type 1 JDRF and the American Diabetes Association, in Collaboration with Multiple Diabetes Organizations Publish New Classification and Staging Approach for Presymptomatic Type 1 Diabetes Organizations Endorse Concept that Autoimmune Disease Begins Long Before Symptoms Occur and Progresses through Distinct Stages, which Provide a Window of Opportunity to Intervene and Prevent Symptomatic Disease New York, NY, September 24, 2015 - JDRF and the American Diabetes Association (Association), announced today that a new classification approach for staging T1D in its earliest presymptomatic stages would be published in the September 24th online version of Diabetes Care. JDRF convened a group of leading diabetes research and clinical organizations to develop the staging approach, which was published as a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association and endorsed by the American Association of Clinical Endocrinologists, the International Society for Pediatric and Adolescent Diabetes, and The Leona M. and Harry B. Charitable Trust. The pre-clinical staging model embraces the concept that T1D begins prior to symptomatic disease and then progresses to a point of certainty for insulin replacement. The staging approach will aid the development of therapies and the design of clinical trials to prevent symptomatic disease and promote precision medicine. Finally, the staging approach will provide a framework to help inform benefit/risk evaluation in the regulatory, reimbursement, and clinical care settings. We know type 1 diabetes begins long before insul Continue reading >>

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