Evaluation of the new ADA and WHO criteria for classification of diabetes mellitus in young adult people (15?34 yrs) in the Diabetes Incidence Study in Sweden (DISS)

Abstract

Most young adults with clinical Type 1 diabetes (199/218, 91%) had objective Type 1 (ab+ at diagnosis/follow-up and/or low fasting plasma C-peptide concentrations at follow-up), as did one third (18/58, 31%) with clinical Type 2 diabetes and more than half (22/37, 59%) with unclassifiable diabetes. About 10% of those who were antibody negative converted to antibody positive. Our study underlines that a classification considering aetiology is superior to clinical judgement.

Excess mortality in incident cases of diabetes mellitus aged 15 to 34 years at diagnosis: a population-based study (DISS) in Sweden

“…In the 1987-1988 cohort we reported that 25% of type 2 diabetes patients had islet cell antibodies at diagnosis [14]. Similarly, in the 1991-1992 cohort [15] we reported that 25-30% of patients with type 2 diabetes had islet antibodies (islet cell antibodies, glutamic acid decarboxylase antibodies, or tyrosine phosphatase antibodies) and in the 1998 year cohort we reported that 25% of patients with clinical type 2 diabetes showed islet antibodies at diagnosis [16]. As we have also previously reported that follow-up of 'type 2 diabetic' patients with islet antibodies demonstrated beta cell failure and insulin dependency within 6 years after diagnosis [17] in these patients, we are well aware of the difficulties in defining type 1 or type 2 diabetes clinically.…”

Normal weight promotes remission and low number of islet antibodies prolong the duration of remission in Type 1 diabetes

“…Symptoms prior to the diagnosis of diabetes and multiple antibodies were more closely related to the length of remissions than C-peptide, which was randomly taken, whereby the variance may have influenced its precision as a prognostic indicator. The prognostic failure of C-peptide measurement at diagnosis may also be related to transient depression of C-peptide secretion due to glucose toxicity [33], as supported by recent studies in the DISS 1998 cohort in which plasma C-peptide represents endogenous insulin secretion 3-6 months after diagnosis, but not at diagnosis [34].…”

Cumulative Risk, Age at Onset, and Sex-Specific Differences for Developing End-Stage Renal Disease in Young Patients With Type 1 Diabetes

“…This change in diagnostic criteria would probably little affect the results, since only clinically overt cases of type 1 diabetes were included. Of all patients, <10% who were classified by clinical criteria as having type 1 diabetes at diagnosis are misclassified when the diagnosis was checked using autoantibodies and C-peptide (24). …”