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The disease process leading to type 1 diabetes starts months or even years before the appearance of clinical symptoms. The duration of the asymptomatic preclinical period is highly individual. It may be a fast process — over a couple of months — and it may also take more than 20 years after the first appearance of diabetes-associated autoantibodies.

Natural history of type 1 diabetes in children and adolescents

  • Preclinical diabetes (may last for a few months up to 20 years)
  • Diagnosis of clinical disease
  • Correction of the metabolic derangements present at diagnosis
  • The remission or ‘honeymoon’ phase: on commencing treatment, children very often experience a partial remission, which may last from a few months up to a few years
  • The end of endogenous insulin secretion, which leads to an increased need for exogenous insulin
  • Puberty and the phase of rapid growth
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Legend
FPIR: first-phase insulin response
GADA: glutamic acid decarboxylase antibodies
IA-2A: insulinoma-associated antigen-2 autoantibodies
IAA: insulin autoantibodies
ICA: islet cell cytoplasmic autoantibodies
IGT: impaired glucose tolerance
ZnT8A: zinc transporter-8 autoantibodies