Idiopathic Type 1 Diabetes in Dallas, Texas

Abstract

OBJECTIVE -To describe the clinical course of individuals with idiopathic type 1 diabetes after a mean of 5 years from diagnosis and to compare glycemic control between those treated with diet and/or oral agents and those treated with insulin at follow-up.RESEARCH DESIGN AND METHODS -Medical records of patients with new-onset diabetes, who presented with unprovoked diabetic ketoacidosis, were reviewed. A total of 54 of these individuals were traceable and had relevant data collected within the past 2 years. All patients had nonsusceptibility HLA haplotypes and no serological evidence of autoimmune type 1 diabetes. Most of these patients were male (41 men and 13 women), were non-Caucasian, were obese at the time of diagnosis (BMI 31.6 Ϯ 6.3 kg/m 2 ), reported weight loss (12.8 Ϯ 9.8 kg), had a family history of type 2 diabetes, and had acanthosis nigricans. At follow-up, 33 patients were still taking insulin and 21 were on diet and/or oral-agent therapy.RESULTS -Both treatment groups were similar in clinical presentation and demographics at diagnosis. After 4.8 Ϯ 1.6 years of follow-up, the 33 patients that were receiving insulin had a lower HbA 1c than the 21 patients who were using therapies other than insulin (7.8 Ϯ 2.4 vs. 11.1 Ϯ 3.5%, P ϭ 0.009; 95% CI 1.0 -6.5%). There was a high correlation between change in weight and change in HbA 1c at follow-up (r ϭ 0.45, P Ͻ 0.001, n ϭ 54). There were no differences in the rate of diabetes complications or in the episodes of recurrent diabetic ketoacidosis.CONCLUSIONS -Idiopathic type 1 diabetes occurs more frequently in male AfricanAmerican patients but also occurs in other ethnic groups. Patients with idiopathic type 1 diabetes who continued to use insulin had better glycemic control than patients using therapies other than insulin. Regained weight is a good clinical marker for improvement in glycemic control. Individuals with this type of diabetes should not be switched to therapies other than insulin.

Type 1 diabetes in Japan

“…Our study indicated that about 10% of Japanese patients with type 1 diabetes have type 1B diabetes without expression of any autoantibodies [70]. Furthermore, these patients had different clinical characteristics from African American or North American patients with idiopathic type 1 diabetes, some of whom, in fact, have type 2 diabetes [71,72].…”

“…It is currently unknown how far this is unique to the Japanese population, but a few cases have been reported from Western countries [72,81]. The underlying pathogenesis remains unclear, although the high frequency of 'flu-like' symptoms just before the onset of fulminant type 1 diabetes suggest that it might be associated with viral infection.…”

Diabetes mellitus in a young Amazon Indian child

“…These individuals can have diabetic ketoacidosis as their initial clinical presentation, but autoimmune islet cell markers are absent at diagnosis and they have physical characteristics similar to type 2 diabetes patients. 10 Asian idiopathic type 1 diabetes cases have different features. Urakami et al 11 reported, among 85 Japanese children with type 1 diabetes, that 16.5% had a new subtype of type 1 diabetes that was characterized by fulminant onset, absolute insulin deficiency and absence of beta-cell autoimmunity markers.…”

Heterogeneidade do diabetes melito tipo 1

“…Esta condição se caracteriza pelo diagnóstico inicial em CAD, um período inicial de necessidade de insulina, ausência dos marcadores imunológicos do DM1A, anos de independência de insulina exógena, como observado no DM2, e episódios de CAD associados a situações de estresse (38). Este tipo de diabetes é mais freqüentemente observado em adultos obesos afro-americanos (39,40), africanos do Subsaara (41), asiáticos (42,43), hispânicos (44) e recentemente foi relatado no Brasil (45).…”

“…Entretanto, a maioria dos investigadores que estudam esta forma de diabetes permanece atribuindo-lhe nomes diferentes, como diabetes tipo 1 de início adulto atípico, diabetes flatbush, diabetes com fase de dependência à insulina, diabetes idiopático e mais recentemente DATC (42,43,48). Isso reflete certa insatisfação com a classificação atual.…”