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

Nature Reviews Endocrinology volume 19, pages 361–370 (2023)Cite this article

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An Author Correction to this article was published on 03 April 2023

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Abstract

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.

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Fig. 1: Management of stage 3a T1DM.
Fig. 2: Relationship between insulin secretion and insulin sensitivity.
Fig. 3: Sites of action of therapeutic interventions for β-cell preservation.

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Authors and Affiliations

  1. Diabetes Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK

    Danijela Tatovic & Colin M. Dayan

  2. Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Parth Narendran

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  1. Danijela Tatovic
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  2. Parth Narendran
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  3. Colin M. Dayan
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Tatovic, D., Narendran, P. & Dayan, C.M. A perspective on treating type 1 diabetes mellitus before insulin is needed. Nat Rev Endocrinol 19, 361–370 (2023). https://doi.org/10.1038/s41574-023-00816-5

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