Adult-onset type 1 diabetes: Current understanding and challenges

R. David Leslie, Carmella Evans-Molina, Jacquelyn Freund-Brown, Raffaella Buzzetti, Dana Dabelea, Kathleen M. Gillespie, Robin Goland, Angus G. Jones, Mark Kacher, Lawrence S. Phillips, Olov Rolandsson, Jana L. Wardian, Jessica L. Dunne

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2449-2456
Number of pages8
JournalDiabetes Care
Issue number11
StatePublished - Nov 1 2021

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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