Non-immune-mediated versus immune-mediated type 1 diabetes: diagnosis and long-term differences—retrospective analysis

Abstract

Background: The American Diabetes Association proposed two subcategories for type 1 diabetes mellitus: type 1A or immune-mediated diabetes (IDM) and type 1B or idiopathic diabetes. The absence of β-cell autoimmune markers, permanent insulinopenia and prone to ketoacidosis define the second category, whose pathogenesis remains unclear. Only a minority of patients fall into this category, also designated non-immune-mediated (NIDM), which is considered by several authors similar to type 2 diabetes. The aim of this study is to evaluate differences at the diagnosis and 10 years later of two categories. Methods: Retrospective cohort study of patients with β-cell autoimmune markers performed at diagnosis and undetectable c-peptide. Were excluded patients with suspicion of another specific type of diabetes. We obtained two groups: IDM (≥ 1 positive antibody) and NIDM (negative antibodies). Age, family history, anthropometry, duration of symptoms, clinical presentation, blood glucose at admission, A1C, lipid profile, arterial hypertension, total diary insulin dose (TDID), microvascular and macrovascular complications were evaluated. Results were considered statistically significant with p < 0.05. Results: 37 patients, 29 with IDM and 8 patients with NIDM. The age of diagnosis of IDM group (23 years) was significantly different (p = 0.004) from the NIDM group (38.1). The body mass index (BMI) at the diagnosis did not differ significantly (p = 0.435). The duration of symptoms was longer in the NIDM (p = 0.003). The disease presentation (p = 0.744), blood glucose (p = 0.482) and HbA1c (p = 0.794) at admission and TDID at discharge (p = 0.301) did not differ significantly. Total and LDL cholesterol levels were higher in NIDM group but did not differ significantly (p = 0.585 and p = 0.579, respectively). After 10 years BMI did not differ between groups (p = 0.079). Patients with IDM showed a significantly higher HbA1c (p = 0.008) and TDID (p = 0.017). Relative to the lipid profile, there was no significant difference, however the LDL cholesterol and triglycerides were higher on the NIDM group, as the percentage of hypertension. Microvascular complications were higher in the IDM group, but no significant difference was found.

Beta Cell Therapies for Preventing Type 1 Diabetes: From Bench to Bedside

“…Autoimmune type 1 diabetes (T1D) mellitus (also referred to as type 1A diabetes) results from insulin deficiency due to autoimmune-mediated destruction of pancreatic beta cells [1]. It often is distinguished from the less common type 1B diabetes, or idiopathic/nonautoimmune diabetes, in which the latter shows insulin deficiency and beta cell loss in the absence of beta cell autoimmunity [2]. T1D incidence has been increasing worldwide for the past few decades [3,4], and while it has a long-standing reputation as a pediatric disease, more recently an increasing number of young adults have been diagnosed [1,3].…”

“…Accordingly, the field has already recognized other distinct, but as yet poorly understood forms of insulin-deficient T1D. These span a spectrum of highly aggressive autoimmunity in fulminant T1D [142] to the absence of beta cell autoimmunity in idiopathic/nonautoimmune T1D [2]. Somewhere between these extremes, and possessing features of both T1D and T2D, is latent autoimmune diabetes in adults (LADA) [143,144], which manifests much later in life than classical T1D.…”

Benefits of Implementation of Insulin Pump in People with Type 1 Diabetes: 10 Case Reports

“…Islet cell autoantibodies and autoantibodies to GAD (glutamic acid decarboxylase, GAD65), insulin, the tyrosine phosphatases islet antigen 2 (IA-2) and Ia-2β, and zinc transporter 8, represent autoimmune markers. Only a minority of people with diabetes fall into the second subcategory, idiopathic T1D, with no evident β-cell autoimmunity, higher susceptibility to ketoacidosis, and permanent insulinopenia [1,2]. The ADA's clinical practice recommendations in "Standards of Medical Care in Diabetes-2022" state that the ideal HbA 1c concentration should be lower than 53 mmol/mol (7%) as it correlates to a 50-76% decrease in microvascular complications (retinopathy, neuropathy, and diabetic kidney disease), development, and progression [3].…”

Non autoimmune type 1B diabetes after mild COVID‐19: Report of three cases

“…A comparison of non immune-mediated versus immune-mediated type 1 diabetes has shown that these patients tend to be older than immune-mediated diabetes, but they have a higher cardiovascular risk resembling the phenotype of type 2 diabetes. 9 Hence, it would be important to follow up these patients for development of vascular complications or sequelae especially since COVID-19 is known to exacerbate the thrombotic and inflammatory pathways in the endothelium. 10 In summary, these three healthy and fit, lean South Asians presented with type 1B insulin-dependent diabetes.…”