In 2015, introduction of a disease staging system offered a framework for benchmarking progression to clinical type 1 diabetes. This model, based on islet autoantibodies (stage 1) and dysglycaemia (stage 2) before type 1 diabetes diagnosis (stage 3), has facilitated screening and identification of people at risk. Yet, there are many limitations to this model as the stages combine a very heterogeneous group of individuals; do not have high specificity for type 1 diabetes; can occur without persistence (ie, reversion to an earlier risk stage); and exclude age and other influential risk factors. The current staging system also infers that individuals at risk of type 1 diabetes progress linearly from stage 1 to stage 2 and subsequently stage 3, whereas such movements are often more complex. With the approval of teplizumab by the US Food and Drug Administration in 2022 to delay type 1 diabetes in people at stage 2, there is a need to refine the definition and accuracy of type 1 diabetes staging. Theoretically, we propose that a type 1 diabetes risk calculator should incorporate any available demographic, genetic, autoantibody, metabolic, and immune data that could be continuously updated. Additionally, we call to action for the field to increase the breadth of knowledge regarding type 1 diabetes risk in non-relatives, adults, and individuals from minority populations.

中文翻译：

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是时候重新构建 1 型糖尿病的疾病分期系统


2015 年，疾病分期系统的引入为临床 1 型糖尿病的进展提供了基准框架。该模型基于 1 型糖尿病诊断（第 3 阶段）之前的胰岛自身抗体（第 1 阶段）和血糖异常（第 3 阶段），有助于筛查和识别高危人群。然而，这个模型有很多局限性，因为这些阶段结合了一个非常异质的个体群体;对 1 型糖尿病没有高特异性;可能在没有持续性的情况下发生（即，恢复到早期风险阶段）;并排除年龄和其他影响风险因素。目前的分期系统还推断，有患 1 型糖尿病风险的个体从 1 期到 2 期，然后是 3 期呈线性进展，而这种运动通常更复杂。随着美国食品药品监督管理局于 2022 年批准 teplizumab 用于延缓 2 期人群的 1 型糖尿病，因此需要完善 1 型糖尿病分期的定义和准确性。从理论上讲，我们建议 1 型糖尿病风险计算器应包含任何可以持续更新的可用人口统计学、遗传学、自身抗体、代谢和免疫数据。此外，我们呼吁该领域采取行动，以增加有关非亲属、成人和少数族裔人群个体的 1 型糖尿病风险的知识广度。