Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis

Hope, Suzy; Wienand-Barnett, Sophie; Shepherd, Maggie; King, Steve; Fox, Charles; Khunti, Kamlesh; Oram, Richard A.; Knight, Bea; Hattersley, Andrew T.; Jones, Angus G.; Shields, Beverley M.

doi:10.3399/bjgp16x684961

Cited by 67 publications

(67 citation statements)

References 29 publications

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“…is often unavailable or not reported. Furthermore, recent studies highlight that clear and correct clinical diagnosis of type 1 and 2 diabetes, monogenic diabetes or pancreatogenic diabetes is more difficult than previously appreciated [27][28][29][30][31][32], emphasising the need for holistic investigation and integration of donor information and research with pancreatic tissue and islets.…”

Section: Suggestions For the Human Islet Research Ecosystemmentioning

confidence: 99%

Use of human islets to understand islet biology and diabetes: progress, challenges and suggestions

2018

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Over the last two decades, improved access to human islets and the development of human islet distribution networks have enabled the use of millions of human islets in hundreds of scientific research projects, leading to a dramatic increase in our understanding of human islet biology. Here we discuss recent scientific advances as well as methodological and experimental challenges that impact human islet quality, experimental outcomes and the reporting of human islets used in scientific publications. In a survey of over 200 scientific publications with human islet experimentation, we found that the reporting of critical information was quite variable, sometimes obscure, and often failed to adequately outline the experiments and results using human islets. As the complexity of human islet research grows, we propose that members of the human islet research ecosystem work together to develop procedures and approaches for accessible and transparent collecting and reporting of crucial human islet characteristics and, through this, enhance collaboration, reproducibility and rigour, leading to further advances in our understanding of human islet biology.

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Section: Suggestions For the Human Islet Research Ecosystemmentioning

confidence: 99%

Use of human islets to understand islet biology and diabetes: progress, challenges and suggestions

2018

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“…For example, more than 50% of patients diagnosed with type 1 diabetes after age 35 years were shown to have type 2 diabetes in long-term follow-up. 4 , 5 Conversely, many older patients initially believed to have type 2 diabetes because of their age at diagnosis deteriorate rapidly and are subsequently found to have type 1 diabetes. 6 Few studies 2 have investigated how frequently type 1 diabetes presents in later life.…”

Section: Introductionmentioning

confidence: 99%

Frequency and phenotype of type 1 diabetes in the first six decades of life: a cross-sectional, genetically stratified survival analysis from UK Biobank

Thomas

Jones

Weedon

et al. 2018

The Lancet Diabetes & Endocrinology

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325

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SummaryBackgroundType 1 diabetes is typically considered a disease of children and young adults. Genetic susceptibility to young-onset type 1 diabetes is well defined and does not predispose to type 2 diabetes. It is not known how frequently genetic susceptibility to type 1 diabetes leads to a diagnosis of diabetes after age 30 years. We aimed to investigate the frequency and phenotype of type 1 diabetes resulting from high genetic susceptibility in the first six decades of life.MethodsIn this cross-sectional analysis, we used a type 1 diabetes genetic risk score based on 29 common variants to identify individuals of white European descent in UK Biobank in the half of the population with high or low genetic susceptibility to type 1 diabetes. We used Kaplan-Meier analysis to evaluate the number of cases of diabetes in both groups in the first six decades of life. We 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. All remaining cases were defined as type 2 diabetes. We assessed the clinical characteristics of the groups with genetically defined type 1 or type 2 diabetes.Findings13 250 (3·5%) of 379 511 white European individuals in UK Biobank had developed diabetes in the first six decades of life. 1286 more cases of diabetes were in the half of the population with high genetic susceptibility to type 1 diabetes than in the half of the population with low genetic susceptibility. These genetically defined cases of type 1 diabetes were distributed across all ages of diagnosis; 537 (42%) were in individuals diagnosed when aged 31–60 years, representing 4% (537/12 233) of all diabetes cases diagnosed after age 30 years. The clinical characteristics of the group diagnosed with type 1 diabetes when aged 31–60 years were similar to the clinical characteristics of the group diagnosed with type 1 diabetes when aged 30 years or younger. For individuals diagnosed with diabetes when aged 31–60 years, the clinical characteristics of type 1 diabetes differed from those of type 2 diabetes: they had a lower BMI (27·4 kg/m2 [95% CI 26·7–28·0] vs 32·4 kg/m2 [32·2–32·5]; p<0·0001), were more likely to use insulin in the first year after diagnosis (89% [476/537] vs 6% [648/11 696]; p<0·0001), and were more likely to have diabetic ketoacidosis (11% [61/537] vs 0·3% [30/11 696]; p<0·0001).InterpretationGenetic susceptibility to type 1 diabetes results in non-obesity-related, insulin-dependent diabetes, which presents throughout the first six decades of life. Our results highlight the difficulty of identifying type 1 diabetes after age 30 years because of the increasing background prevalence of type 2 diabetes. Failure to diagnose late-onset type 1 diabetes can have serious consequences because these patients rapidly develop insulin dependency.FundingWellcome Trust and Diabetes UK.

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“…The rarity of type 1 diabetes in older adults means that it is very hard to separate type 1 diabetes from an unusual presentation of type 2 diabetes. Errors are therefore common, with 'posthoneymoon' C-peptide studies showing that~50% of those treated with insulin from diagnosis do not have type 1 diabetes [3] and that~40% of those with definite type 1 diabetes are initially treated with tablets [4]. This means reassessment of diagnosis in older adults treated with insulin is crucial.…”

mentioning

confidence: 99%

“…A. G. Jones 1,2 , B. M. Shields 1 , J. M. Dennis 1 , A. T. Hattersley 1,2 , T. J. McDonald 1,3 and N. J.…”

mentioning

confidence: 99%

The challenge of diagnosing type 1 diabetes in older adults

et al. 2020

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Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis

Cited by 67 publications

References 29 publications

Use of human islets to understand islet biology and diabetes: progress, challenges and suggestions

Use of human islets to understand islet biology and diabetes: progress, challenges and suggestions

Frequency and phenotype of type 1 diabetes in the first six decades of life: a cross-sectional, genetically stratified survival analysis from UK Biobank

The challenge of diagnosing type 1 diabetes in older adults

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