Traditional Diabetes Classifications Apply to Youths

Youths in nonautoimmune, IS category likely to have undetected autoimmunity, monogenic DM

MONDAY, July 11 (HealthDay News) -- Most youths with diabetes have characteristics similar to traditional descriptions of type 1 and type 2 diabetes, according to a study published in the July issue of Diabetes Care.

Dana Dabelea, M.D., Ph.D., from the University of Colorado Denver in Aurora, and colleagues described the classification of diabetes type in youth by etiological approach, based on the 1997 American Diabetes Association (ADA) framework. Data from 2,219 patients, aged younger than 20 years, with recently diagnosed diabetes were collected from the SEARCH for Diabetes in Youth Study. The main etiologic markers were autoimmunity and insulin sensitivity, based on which four categories were described along a bidimensional spectrum. Differences in characteristics, including genetic susceptibility to autoimmunity (HLA genotypes), insulin deficiency, and clinical factors were assessed across the categories.

The investigators found that 54.5 percent of patients fell in the autoimmune plus insulin-sensitive (IS) category and 15.9 percent fell in the nonautoimmune plus insulin-resistant (IR) category, with characteristics similar to traditional descriptions of type 1 or 2 diabetes. Similar prevalence and titers of diabetes autoantibodies and distribution of HLA risk genotypes were seen in autoimmune plus IR and autoimmune plus IS categories, indicating that it includes obese patients with type 1 diabetes. Patients from the nonautoimmune plus IS category were likely to have undetected autoimmunity and may have monogenic diabetes.

"This study is the first attempt to provide operational definitions of types of diabetes using an etiological approach, as recommended by the ADA expert committee" the authors write.

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