Adult-Onset Type 1 Diabetes: Current Understanding and Challenges

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 d...

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Vydáno v:	Diabetes care Ročník 44; číslo 11; s. 2449
Hlavní autoři:	Leslie, R David, Evans-Molina, Carmella, Freund-Brown, Jacquelyn, Buzzetti, Raffaella, Dabelea, Dana, Gillespie, Kathleen M, Goland, Robin, Jones, Angus G, Kacher, Mark, Phillips, Lawrence S, Rolandsson, Olov, Wardian, Jana L, Dunne, Jessica L
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.11.2021
Témata:	Autoantibodies C-Peptide Child Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 1 - genetics Diabetes Mellitus, Type 2 - drug therapy Glutamate Decarboxylase Humans Insulin - therapeutic use
ISSN:	1935-5548, 1935-5548
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Abstract	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 diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions 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 dominant. 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.
AbstractList	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 diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions 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 dominant. 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.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 diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions 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 dominant. 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. 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 diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions 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 dominant. 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.
Author	Dabelea, Dana Dunne, Jessica L Leslie, R David Buzzetti, Raffaella Phillips, Lawrence S Wardian, Jana L Kacher, Mark Evans-Molina, Carmella Goland, Robin Gillespie, Kathleen M Rolandsson, Olov Freund-Brown, Jacquelyn Jones, Angus G
Author_xml	– sequence: 1 givenname: R David orcidid: 0000-0002-1786-1531 surname: Leslie fullname: Leslie, R David email: cevansmo@iu.edu, r.d.g.leslie@qmul.ac.uk organization: Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, U.K. cevansmo@iu.edu r.d.g.leslie@qmul.ac.uk – sequence: 2 givenname: Carmella orcidid: 0000-0001-7764-8663 surname: Evans-Molina fullname: Evans-Molina, Carmella email: cevansmo@iu.edu, r.d.g.leslie@qmul.ac.uk organization: Richard L. Roudebush VA Medical Center, Indianapolis, IN – sequence: 3 givenname: Jacquelyn surname: Freund-Brown fullname: Freund-Brown, Jacquelyn organization: JDRF, New York, NY – sequence: 4 givenname: Raffaella orcidid: 0000-0003-1490-6041 surname: Buzzetti fullname: Buzzetti, Raffaella organization: Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy – sequence: 5 givenname: Dana surname: Dabelea fullname: Dabelea, Dana organization: Lifecourse Epidemiology of Adiposity & Diabetes Center, Colorado School of Public Health, and Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO – sequence: 6 givenname: Kathleen M orcidid: 0000-0002-3009-8032 surname: Gillespie fullname: Gillespie, Kathleen M organization: Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K – sequence: 7 givenname: Robin surname: Goland fullname: Goland, Robin organization: Naomi Berrie Diabetes Center, Columbia University, New York, NY – sequence: 8 givenname: Angus G orcidid: 0000-0002-0883-7599 surname: Jones fullname: Jones, Angus G organization: Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K – sequence: 9 givenname: Mark surname: Kacher fullname: Kacher, Mark organization: JDRF, New York, NY – sequence: 10 givenname: Lawrence S surname: Phillips fullname: Phillips, Lawrence S organization: Atlanta VA Medical Center and Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA – sequence: 11 givenname: Olov orcidid: 0000-0002-1341-6828 surname: Rolandsson fullname: Rolandsson, Olov organization: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden – sequence: 12 givenname: Jana L surname: Wardian fullname: Wardian, Jana L organization: College of Medicine, University of Nebraska Medical Center, Omaha, NE – sequence: 13 givenname: Jessica L orcidid: 0000-0002-0134-4177 surname: Dunne fullname: Dunne, Jessica L organization: JDRF, New York, NY
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SubjectTerms	Autoantibodies C-Peptide Child Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 1 - genetics Diabetes Mellitus, Type 2 - drug therapy Glutamate Decarboxylase Humans Insulin - therapeutic use
Title	Adult-Onset Type 1 Diabetes: Current Understanding and Challenges
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