For Beta or Worse? Quantifying beta cell function in the preclinical stages of type 1 diabetes

The 2024 American Diabetes Association (ADA) Standards of Care in Diabetes tell us that once hyperglycaemia occurs, people with all forms of diabetes are at risk for developing the same chronic complications, although rates of progression may differ.

The identification of individualized therapies for diabetes in the future will be informed by better characterization of the many paths culminating in beta-cell demise or dysfunction.

It is noteworthy for health care professionals to recognize that the classification of diabetes type is not always straightforward at presentation. Misdiagnosis is common and can occur in 40% of adults with new onset type 1 diabetes who were initially diagnosed as having type 2 diabetes. Thus ‘getting it right’ as soon as possible after a diagnosis of diabetes can have major implications for the direction and quality care provided going forward. As an example, being able to prevent an episode of diabetic ketoacidosis (DKA) is very meaningful to the person with diabetes and their family.

The ADA guidelines share a framework of how best to consider an approach here:

American Diabetes Association Professional Practice Committee (2024) 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2024. Diabetes Care 47(Suppl. 1): S20–S42

Additionally, the ADA offers an algorithmic construct when suspecting new onset type 1 diabetes in an adult. Our May Journal Club session will focus on the preclinical stages of type 1 diabetes.