Building Competency in Diabetes Education THE ESSENTIALS

3-14 | CHAPTER 3

and environmental factors (12,17). Diabetic ketoacidosis (DKA) may or may not be present at diagnosis (18).

Staging of Type 1 Diabetes Skyler et al. (2017) suggested three stages for development of type 1 diabetes (19): • Stage 1 - presymptomatic, normoglycemic, but with autoimmunity characterized by two or more autoantibodies • Stage 2 - dysglycemia (IFG and/or IGT) and continued autoimmunity • Stage 3 - symptomatic hyperglycemia is established This model not only reflects the continuous process of beta cell mass and function decline long before the clinical symptoms of type 1 diabetes, but also provides unique opportunity to study disease evolution with consideration of diabetes prevention and insulin production preservation. Approaching type 1 diabetes as a chronic, three stage complex condition potentially can help to reduce hospitalizations and DKA occurrence in newly diagnosed individuals. Genetic considerations in type 1 diabetes (5) From a genetic perspective, type 1 diabetes is a polygenetic condition in which susceptibility involves multiple genes. It is considered that the major susceptibility gene is located in the HLA region on chromosome 6. It is important to remember that most people with type 1 diabetes (around 75%) do not have a first-degree relative with this condition and many individuals with predisposing genes do not develop diabetes. Hence, type 1 diabetes is associated with complex interactions of genetic, environmental and immunologic factors. Latent autoimmune diabetes in adults Slowly progressive form of diabetes in a lean adult may be initially diagnosed as type 2 or type 1 diabetes, but may actually be latent autoimmune diabetes in adults (LADA) (20). It has been estimated that 10 to 15% of those diagnosed with type 2 diabetes actually have LADA (21). Circulating ICA and GAD, specifically GAD 65, may differentiate this from type 2 diabetes, but these antibody tests are not routinely performed in many settings (21). Clinically, LADA resembles type 2 diabetes; some studies report similar insulin resistance present in LADA patients as in type 2 diabetes (20). However, other studies found that the features in LADA