Benicio child with type 1 diabetes mellitus. Diagnostic criteria in type 1 diabetes mellitus. Is it time for change?

Abstract

Type 1 diabetes mellitus (DM1) is the prototypical form of DM mediated by autoimmunity. Classically, DM1 is classified as presymptomatic DM1, characterized by a decrease in the mass of β cells without symptoms, and symptomatic DM1, in which stage the symptoms of hyperglycemia become evident. Alternatively, DM1 can be subdivided into three stages: stage 1 characterized by the presence of autoantibodies and absence of dysglycemia; stage 2 characterized by the presence of autoantibodies and dysglycemia, and stage 3 in which symptoms appear (DM1 symptomatic).

Despite the great advance in the understanding of the natural history of DM1, the diagnostic criteria defined by the American Diabetes Association (ADA) in 1997 are still used and have changed slightly over the years. The community has taken important steps towards a better diagnosis of DM1, which challenge old dogmas, such as that DM1 occurs only in children and DM2 only in adults, or that obesity prevents the diagnosis of DM1. In this sense, it would be important to recognize the "pre-diabetic" stage as an integral part of the diagnosis of DM1, as is the case today for patients with other autoimmune diseases. The presence of two or more circulating islet autoantibodies and dysglycemia should now be used as diagnostic criteria for DM1, thus recognizing the first stage of the disease: insulin-independent type 1 diabetes, which precedes the stage of type 1 diabetes. (insulin dependent) for almost all patients. Anticipating the diagnosis of DM1 would provide real benefits for patients.

Finally, it is important to have improved platforms to measure islet autoantibodies that make detection feasible in the general population. Early identification of preclinical DM will allow for less diabetic ketoacidosis, earlier initiation of insulin therapy, and the potential to delay or prevent the onset of DM1.