Diabetes Metab J.  2012 Apr;36(2):90-97. 10.4093/dmj.2012.36.2.90.

Challenges in Diagnosing Type 1 Diabetes in Different Populations

• Rewers M

• KMID: 2281410
• DOI: http://doi.org/10.4093/dmj.2012.36.2.90

Abstract

Diabetes affects today an estimated 366 million people world-wide, including 20 million to 40 million of patients with type 1 diabetes (T1D). While T1D accounts for 5% to 20% of those with diabetes, it is associated with higher morbidity, mortality and health care cost than the more prevalent type 2 diabetes. Patients with T1D require exogenous insulin for survival and should be identified as soon as possible after diagnosis to avoid high morbidity due to a delay in insulin treatment. It is also important to present to the patient correct prognosis that differs by the type of diabetes. From the research point of view, correct classification should help to identify the etiologies and to develop specific prevention for T1D. This review summarizes evidence that may be helpful in diagnosing T1D in various ethnic groups. Challenges in interpretation of results commonly used to determine the type of diabetes are highlighted.

Keyword

African diabetes; C-peptide; Diabetes mellitus, type 1; Diagnostic criteria; Ethnic differences; Fulminant diabetes; Genetics; Insulin sensitivity; Islet autoantibodies

MeSH Terms

C-Peptide
Diabetes Mellitus, Type 1
Ethnic Groups
Health Care Costs
Humans
Insulin
Insulin Resistance
Prognosis
C-Peptide
Insulin

Figure

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  Fig. 1 Current classification of diabetes. APS1, autoimmune polyendocrine syndromes 1; IPEX, immunodeficiency, polyendocrinopathy, enteropathy, X-linked syndrome; MODY, maturity-onset diabetes of the young.

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  Fig. 2 Distribution of body mass index (BMI) at diagnosis by type of diabetes, age 10 to 19 years. Barbara Davis Center for Diabetes, Denver, USA.

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  Fig. 3 Practical diabetes classification algorithm in U.S. patients <20 years at diagnosis. IAA, autoantibodies to insulin; GADA, glutamic acid decarboxylase; IA-2A, the tyrosine phosphatase insulinoma antigen; ZnT8A, zinc transporter 8; T1aD, type 1a (autoimmune) diabetes; T2D, type 2 diabetes. *Needs to be refined for non-white populations groups.

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