Brian K. Crownover, MD, FAAFP
Eglin AFB Family Medicine Residency, 96th Medical Group, Headquarters Air Armament Center, Eglin Air Force Base, Fla
Joan Nashelsky, MLS
Family Physicians Inquiries Network, Inc, Iowa City
the 1 last update 15 Jul 2020
No clinical characteristic or diagnostic test is available to readily distinguish type 1 from type 2 diabetes mellitus. Although C-peptide levels, autoantibodies, and adiponectin-to-leptin ratios show some utility, they do not yet have a standard diagnostic role; research on the pathophysiology of diabetes suggests that the classic type 1 and type 2 distinctions may not be appropriate for all patients1 (strength of recommendation: C, based on expert opinion).
Onset of diabetes in childhood with ketoacidosis and insulin dependency has traditionally been sufficient to diagnose type 1 diabetes, while onset in older, obese patients with primary insulin resistance suggested type 2 diabetes. Unfortunately, features of type 1 and type 2 diabetes may be present in the same patient, making differentiation difficult. No diagnostic studies in the literature were identified that definitively demonstrate how to separate type 1 from type 2 diabetes.
reverses diabetes type 2 symptoms women (☑ carbs allowed per day) | reverses diabetes type 2 google scholarhow to reverses diabetes type 2 for A patient’s age may suggest, but does not reliably distinguish, diabetes types. A study of 569 new-onset type 1 and type 2 diabetic children and adolescents showed that older age was only weakly associated with type 2 diagnosis (odds ratio [OR]= 1.4 for each 1-year increment in age; 95% confidence interval [CI], 1.3–1.6).2 In fact, newly diagnosed 12-year-old children have an equal incidence of type 1 as type 2 diabetes. Likewise, adults with type 2 phenotype (no initial insulin requirement) can present with positive autoantibodies typically found in younger type 1 patients. Older patients who fit this profile have been classified as type 1.5 diabetes or latent autoimmune disease in adults (LADA).3
reverses diabetes type 2 nails (☑ treatment guidelines) | reverses diabetes type 2 remissionhow to reverses diabetes type 2 for A history of diabetic ketoacidosis (DKA) also does not reliably distinguish between types 1 and 2. A retrospective chart review gathered data on adults over 18 years of age who were admitted for DKA in a urban US hospital. Many patients with DKA for 1 last update 15 Jul 2020 were subsequently diagnosed with type 2 diabetes. Rates of type 2 diabetes in patients with DKA varied by race: 47% of Hispanics, 44% of African Americans, and 17% of Caucasians had type 2 diabetes.4A history of diabetic ketoacidosis (DKA) also does not reliably distinguish between types 1 and 2. A retrospective chart review gathered data on adults over 18 years of age who were admitted for DKA in a urban US hospital. Many patients with DKA were subsequently diagnosed with type 2 diabetes. Rates of type 2 diabetes in patients with DKA varied by race: 47% of Hispanics, 44% of African Americans, and 17% of Caucasians had type 2 diabetes.4
The overlapping presence of autoantibodies in both types of diabetes limits their use (TABLE). Autoantibodies do predict an earlier need for insulin. One prevalence study of 101 type 2 adult patients found 20% were positive for glutamic acid decarboxylase autoantibody (GADAb), which was positively associated with insulin dependence at 4 years postdiagnosis (OR=5.8; 95% CI, 1.8–18.9).5 Eighty percent of patients with autoantibodies required insulin compared with 41% of patients without autoantibodies. Another study in young adults with type 2 or unclassified diabetes from Sweden found 93% of patients who were GADAb+ required insulin at 3 years, compared with 51% who were GADAb–(OR=18.8; 95% CI, 1.8–191).6
Evidence-based answers from the Family Physicians Inquiries Network