TY - JOUR
T1 - Adult-onset type 1 diabetes
T2 - Current understanding and challenges
AU - David Leslie, R.
AU - Evans-Molina, Carmella
AU - Freund-Brown, Jacquelyn
AU - Buzzetti, Raffaella
AU - Dabelea, Dana
AU - Gillespie, Kathleen M.
AU - Goland, Robin
AU - Jones, Angus G.
AU - Kacher, Mark
AU - Phillips, Lawrence S.
AU - Rolandsson, Olov
AU - Wardian, Jana L.
AU - Dunne, Jessica L.
N1 - Publisher Copyright:
© 2021 by the American Diabetes Association.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults. Key genetic, immune, and metabolic differences exist between adult-and childhood-onset type 1 diabetes, many of which are not well understood. A substantial risk of misclassification of diabetes type can result. Notably, some adults with type 1 diabetes may not require insulin at diag-nosis, their clinical disease can masquerade as type 2 diabetes, and the conse-quent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in Novem-ber 2019. Here, we summarize the current understanding and unanswered ques-tions in the field based on those discussions, highlighting epidemiology and immunogenetic and metabolic characteristics of adult-onset type 1 diabetes as well as disease-associated comorbidities and psychosocial challenges. In adult-onset, as compared with childhood-onset, type 1 diabetes, HLA-associated risk is lower, with more protective genotypes and lower genetic risk scores; multiple diabetes-associated autoantibodies are decreased, though GADA remains domi-nant. Before diagnosis, those with autoantibodies progress more slowly, and at diagnosis, serum C-peptide is higher in adults than children, with ketoacidosis being less frequent. Tools to distinguish types of diabetes are discussed, including body phenotype, clinical course, family history, autoantibodies, comorbidities, and C-peptide. By providing this perspective, we aim to improve the management of adults presenting with type 1 diabetes.
AB - Recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults. Key genetic, immune, and metabolic differences exist between adult-and childhood-onset type 1 diabetes, many of which are not well understood. A substantial risk of misclassification of diabetes type can result. Notably, some adults with type 1 diabetes may not require insulin at diag-nosis, their clinical disease can masquerade as type 2 diabetes, and the conse-quent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in Novem-ber 2019. Here, we summarize the current understanding and unanswered ques-tions in the field based on those discussions, highlighting epidemiology and immunogenetic and metabolic characteristics of adult-onset type 1 diabetes as well as disease-associated comorbidities and psychosocial challenges. In adult-onset, as compared with childhood-onset, type 1 diabetes, HLA-associated risk is lower, with more protective genotypes and lower genetic risk scores; multiple diabetes-associated autoantibodies are decreased, though GADA remains domi-nant. Before diagnosis, those with autoantibodies progress more slowly, and at diagnosis, serum C-peptide is higher in adults than children, with ketoacidosis being less frequent. Tools to distinguish types of diabetes are discussed, including body phenotype, clinical course, family history, autoantibodies, comorbidities, and C-peptide. By providing this perspective, we aim to improve the management of adults presenting with type 1 diabetes.
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U2 - 10.2337/dc21-0770
DO - 10.2337/dc21-0770
M3 - Article
C2 - 34670785
AN - SCOPUS:85120149973
SN - 0149-5992
VL - 44
SP - 2449
EP - 2456
JO - Diabetes Care
JF - Diabetes Care
IS - 11
ER -