JAMA Clinical Reviews Type 1 Diabetes: Diagnosis and Management
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Feb 16, 2026 Desmond Schatz, Professor of Pediatrics and type 1 diabetes researcher and clinician, joins to unpack diagnosis and care. He outlines definitions and prevalence, contrasts pathophysiology with type 2, and reviews antibody and C‑peptide testing. He covers genetic risk, possible viral triggers, stages of progression, latent adult forms, insulin delivery options, hybrid closed‑loop systems, continuous glucose monitoring, and goal metrics.
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Use C-Peptide To Gauge Residual Insulin
- Measure C-peptide to assess residual endogenous insulin when low values are found.
- Remember that C-peptide can be normal or elevated early in adult-onset or overweight patients, so interpret cautiously.
Population Versus Familial Risk
- Most cases (85–90%) arise in the general population; only 10–15% occur in first-degree relatives.
- Relatives still carry higher risk (about 1 in 20 vs 1 in 300 in general population) and often have high-risk HLA alleles DR3/DR4.
Viruses May Trigger Clinical Onset
- Viral infections can precipitate clinical onset in people already positive for multiple autoantibodies.
- No single virus has been definitively proven as the trigger for type 1 diabetes.