Diabetes Metab J.  2023 Jan;47(1):140-146. 10.4093/dmj.2021.0322.

Comparison of Insulin-Treated Patients with Ambiguous Diabetes Type with Definite Type 1 and Type 2 Diabetes Mellitus Subjects: A Clinical Perspective

• Laspe I
• Meier JJ
• Nauck MA

• KMID: 2538938
• DOI: http://doi.org/10.4093/dmj.2021.0322

Abstract

In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with “ambiguous” diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (P<0.0001). In conclusion, a substantial proportion of diabetes patients in a tertiary care centre presented with an “ambiguous” diabetes type. Their clinical characteristics fall in between those of definite T1DM or T2DM patients.

Keyword

C-peptide; Diabetes mellitus, type 1; Diabetes mellitus, type 2; Diagnosis, differential; Insulin resistance; Latent autoimmune diabetes in adults

Figure

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  Fig. 1. Plasma glucose concentration profiles (mean±standard error of the mean; and (A) coefficients of variation of fasting plasma glucose concentrations (bars indicate mean±95% confidence intervals; (B) determined after optimizing glucose-lowering therapy (e.g., insulin dose titration); and (C) frequency distribution of individually calculated diabetes type scores in our cohorts with unequivocal type 1 (green) and type 2 (blue) diabetes mellitus (T1DM and T2DM) and with ambiguous diabetes type (red). The scores were calculated such that, ideally, a subjects with T1DM should receive a score of 1, and subjects with T2DM should receive a score of 2. Repeated measures analysis of variance (A), analysis of variance with post hoc tests (Duncan’s test; B).

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