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American scientists have suggested that the diabetic disease process can be staged into various phases. Stage 1 is characterised by beta cell autoimmunity, but the individual is still normoglycaemic. In stage 2, we have dysglycaemia in addition to the beta cell autoimmunity, and stage 3 is defined by the appearance of symptoms, and is known as clinical diabetes. In birth cohort studies it has been noted that the first autoantibodies may appear very early, even before the age of one year. And it seems that the majority of those individuals who present with clinical diabetes before puberty seroconvert to antibody positivity before the age of three years. It has been implied that, at the time of diagnosis, about 20 to 40% of the beta cells are still functioning. After diagnosis, in many patients we see a remission phase, characterised by improved insulin secretion, but gradually the insulin secretion fails and the patient becomes almost completely dependent on exogenous insulin.
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Knip M, Luopajärvi K, Härkönen T. Early life origin of type 1 diabetes. Semin Immunopathol. 2017 Nov;39(6):653-667.