Years ago, type 1 diabetes was often called “juvenile diabetes” which is a term that wasn’t accurate because of how not all type 1 diabetes diagnosis happen in childhood. Over time we’ve learned just how inaccurate that term indeed was.
Among those with a high genetic risk for type 1 diabetes, at what age do they most often develop type 1 diabetes well into adulthood and what are the clinical characteristics of those patients?
Researchers conducted a cross-sectional analysis using a type 1 diabetes genetic risk score that was based on 29 common variants to pinpoint individuals of white European descent in the UK Biobank “in the half of the population with high or low genetic susceptibility to type 1 diabetes, ” wrote the researchers in their study abstract.
They looked at the number of cases of diabetes in both of those groups over their first 60 years of life and then “genetically defined type 1 diabetes as the additional cases of diabetes that occurred in the high genetic susceptibility group compared with the low genetic susceptibility group”.
Remaining cases were defined as type 2 diabetes and the clinical characteristics of the groups with genetically defined type 1 or 2 diabetes were investigated.
Researchers found that 13,250 of the 379,511 individuals from the UK Biobank had developed diabetes in their first 60 years of life. They write that 537 or 42% of individuals were diagnosed between age 31-60 which comprised 4% of the total diabetes cases diagnosed after age 30.
The clinical characteristics in those diagnosed with type 1 diabetes after age 30 were similar to those diagnosed with type 1 under age 30 and different from those diagnosed with type 2 diabetes. All those diagnosed with type 1 diabetes generally had a lower BMI, were more likely to use insulin in their first year of diagnosis, and were more likely to develop diabetic ketoacidosis.
Diagnosing Type 1 in Adults is Daunting
These findings show that type 1 diabetes often develops in individuals after age 30, but since these cases of type 1 diabetes are such a small percentage of cases, with type 2 diabetes being the overwhelming majority and therefore likelihood, properly identifying type 1 diabetes in this age group is very challenging.
Yet, failing to do so can lead to “serious consequences because these patients rapidly develop insulin dependency”.
The researchers state that tests that check C-peptide and islet-specific autoantibodies can be used to figure out if a patient has type 1 or 2 diabetes but these tests aren’t routinely done and sometimes aren’t enough.
They write that “Progression to absolute insulin deficiency, defined by measurement of serum C-peptide concentration, can be used to identify type 1 diabetes, but is only useful 3–5 years after diagnosis.”
Sometimes, to diagnose type 1 diabetes, healthcare providers use a test that looks for autoantibodies to the GAD islet antigen but that isn’t a sure thing because only about 70% of type 1 patients have those autoantibodies.
All this despite the other complications for professionals trying to figure out which diabetes a patient has like the way that patients diagnosed later in life tend to have a slower progression of type 1 diabetes compared to children which can make them look like a type 2, at least initially.
In conclusion, the researchers explain that half of the population has a very low genetic risk for type 1 which means that if they develop diabetes, it is most likely to be type 2 diabetes. The other half of the population with a high risk for type 1 diabetes has a likelihood for either type 1 or 2 diabetes, leaving medical professionals struggling to properly identify patients.
Were you diagnosed with type 1 diabetes as an adult? Was there trouble getting a diagnosis? Please share in the comments.
Originally published by Sysy Morales at Diabetes Daily
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