Late-onset type 1 diabetes frequently misdiagnosed
medwireNews: Research shows that being diagnosed with type 1 diabetes after the age of 30 years is relatively common, yet people are often misdiagnosed with type 2 diabetes, despite rapid progression to insulin dependence.
The study authors found that 21% of 583 participants of the Diabetes Alliance for Research in England (DARE) population cohort fitted this category, being older than 30 years at diabetes diagnosis but with severe endogenous insulin deficiency, defined as insulin treatment within 3 years and C-peptide levels below 200 pmol/L.
However, 20% of these people believed they had type 2 diabetes, compared with none of the 220 people who had severe endogenous insulin deficiency but had been diagnosed before the age of 31 years. And 38% did not receive insulin from the point of diagnosis, instead starting it a median of 12 months later.
The “classical clinical criteria” for type 1 diabetes could not reliably identify these people who were relatively old at diagnosis; for example, only 41% had a healthy BMI, report Angus Jones (University of Exeter Medical School, UK) and study co-authors in Diabetologia.
But 85% progressed to insulin treatment within 1 year of diagnosis, and only 4% lasted more than 3 years before they needed exogenous insulin.
“Our results suggest that if patients are treated as having type 2 diabetes but progress to insulin within 3 years of diagnosis, clinicians should reassess the underlying diagnosis and strongly consider biomarker testing,” write the researchers.
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