Type 1 diabetes (T1D) is an autoimmune disease characterised by immune-mediated destruction of pancreatic β-cells. This process evolves over months to years and precedes clinical hyperglycaemia.
Early-stage (presymptomatic) T1D is defined by the presence of two or more islet autoantibodies, indicating established autoimmune disease despite normoglycaemia or mild dysglycaemia, and absence of symptoms. At this stage, insulin therapy is not yet required, but disease progression is predictable and measurable, particularly in children.
Staging of early T1D
- Stage 1: Two or more autoantibodies present; normoglycaemia; preserved insulin secretion. HbA1c less than 39mmol/mol
- Stage 2: Two or more autoantibodies with dysglycaemia; asymptomatic. HbA1c 39-47mmol/mol
- Stage 3: Clinical T1D with hyperglycaemia, symptoms, and insulin dependence. HbA1c 48mmol/mol or more
Early T1D (stage 1 and 2) has a distinct SNOMED and ICD10 code to that of established stage 3 disease. Early identification enables structured surveillance, risk stratification, prevention of DKA at presentation, and timely referral to specialist services and disease-modifying therapies where available.
We've gathered a range of health care resources on the topic of early T1D. These resources are designed for secondary care teams to support evidence-based follow-up of individuals with early T1D, outlining staging, monitoring pathways, referral thresholds, and emerging therapeutic and research opportunities. Early, coordinated action can improve safety, clinical readiness, and long-term outcomes. The resources have been reviewed by ABCD but created by other healthcare professionals or clinical services.
