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Diabetologia. 2017 Jan;60(1):35-38. Epub 2016 Oct 26.

Rebranding asymptomatic type 1 diabetes: the case for autoimmune beta cell disorder as a pathological and diagnostic entity.

Author information

1
DFG Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 105, 01307, Dresden, Germany. ezio.bonifacio@crt-dresden.de.
2
Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Technische Universität Dresden, Dresden, Germany. ezio.bonifacio@crt-dresden.de.
3
Clinical and Experimental Endocrinology, University Hospital of Leuven, Leuven, Belgium.
4
Benaroya Research Institute at Virginia Mason, The University of Washington School of Medicine, Seattle, WA, USA.
5
Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.
6
Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.
7
T1D Exchange, Boston, MA, USA.
8
Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA.
9
Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
10
Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.
11
University of California, San Francisco Diabetes Center, San Francisco, CA, USA.
12
McNair Medical Institute, Pediatric Diabetes and Endocrinology, Baylor College Medical Center, Houston, TX, USA.
13
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
14
Department of Immunobiology, King's College London Faculty of Life Sciences & Medicine, London, UK.
15
National Institute of Health Research Biomedical Research Centre at Guy's and St Thomas' Hospitals and King's College London, London, UK.
16
Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University School of Medicine, Nashville, TN, USA.
17
VA Tennessee Valley Healthcare System, Nashville, TN, USA.
18
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.
19
Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.

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.

KEYWORDS:

Autoimmunity; Beta cell; Diabetes; Disease classification

PMID:
27785529
PMCID:
PMC5516264
DOI:
10.1007/s00125-016-4144-8
[Indexed for MEDLINE]
Free PMC Article

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