Preventing autoimmune type 1 diabetes (T1D) necessitates improved monitoring for disease progression before symptom onset. Current diagnostic methods assess circulating autoantibodies, C-peptide levels, or dysglycemia, yet these approaches fail to identify β cell destruction preceding glucose dysregulation. Here, a subcutaneous microporous scaffold is used as an immunological niche (IN), which provides a nonvital accessible tissue reflecting many immune changes occurring in the pancreas. Sequencing analysis of the IN successfully delineates at-risk from nonrisk groups, as well as disease progressors from nonprogressors at 6 weeks of age in the nonobese diabetic mouse model. Within progressors, we identify disease 5 to 7 weeks before disease onset. Collectively, disease occurring in a poorly accessible site can be identified early by sampling a distant nonvital tissue, indicating the systemic nature of the disease and informing the timing of disease modifying therapies to halt or delay the progression of T1D.
King et al. (2026) studied this question.