dc.contributor.author | Thomas, N | |
dc.contributor.author | Lynam, A | |
dc.contributor.author | Hill, A | |
dc.contributor.author | Weedon, M | |
dc.contributor.author | Shields, B | |
dc.contributor.author | Oram, R | |
dc.contributor.author | McDonald, T | |
dc.contributor.author | Hattersley, A | |
dc.contributor.author | Jones, AG | |
dc.date.accessioned | 2019-02-25T10:11:36Z | |
dc.date.issued | 2019-04-10 | |
dc.description.abstract | Aims/ hypothesis
Late onset type 1 diabetes can be difficult to identify. Measurement of endogenous insulin secretion,
using C-peptide, provides a gold standard classification in longstanding diabetes that closely relates
to treatment requirements. We aimed to determine the prevalence and characteristics of type
1 diabetes defined by severe endogenous insulin deficiency after age 30 and assess whether
these patients are identified and managed as having type 1 diabetes in clinical practice.
Methods
We assessed the characteristics of type 1 diabetes defined by rapid insulin requirement
(within 3 years of diagnosis) and severe endogenous insulin deficiency (non-fasting Cpeptide <200pmol/l) within 583 participants with insulin treated diabetes diagnosed after
age 30 from the DARE population cohort. We compared characteristics with participants
with retained endogenous insulin secretion (>600pmol/L) and 220 participants with severe
insulin deficiency diagnosed under age 30.
Results
Twenty one percent of participants with insulin treated diabetes diagnosed after age 30 met
study criteria for type 1 diabetes. Of these participants, 38% did not receive insulin at
diagnosis, of whom 47% self-reported type 2 diabetes. Rapid insulin requirement was highly
predictive of severe endogenous insulin deficiency: 85% required insulin within 1 year of
diagnosis, and 57% of those progressing to insulin within 3 years of diagnosis had type 1
diabetes. Participants with late onset type 1 diabetes defined by development of severe
insulin deficiency had similar clinical characteristics to those with young onset type 1
diabetes. However those with later onset type 1 diabetes had modestly lower type 1
diabetes genetic risk score (0.268 vs 0.279, p<0.001, expected type 2 diabetes population
median 0.231), higher islet autoantibody prevalence (GAD, IA2 or ZnT8 positive 78 vs 62% at
13 vs 26 years diabetes duration, p=0.02), and were less likely to identify as having type 1
diabetes (79 vs 100%, p<0.001).
Conclusion
Type 1 diabetes diagnosed over 30 years of age, defined by severe insulin deficiency has
similar clinical and biological characteristics to when occurring at younger ages, but is
frequently not identified. Clinicians should be aware that patients progressing to insulin
within 3 years of diagnosis have a high likelihood of type 1 diabetes, regardless of initial
diagnosis. | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.description.sponsorship | European Foundation for the Study of Diabetes | en_GB |
dc.description.sponsorship | Diabetes UK | en_GB |
dc.identifier.citation | Published online 10 April 2019. | en_GB |
dc.identifier.doi | 10.1007/s00125-019-4863-8 | |
dc.identifier.grantnumber | CS-2015-15-018 | en_GB |
dc.identifier.grantnumber | 16/0005529 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/36043 | |
dc.language.iso | en | en_GB |
dc.publisher | Springer Verlag | en_GB |
dc.rights | © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. | |
dc.title | Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-02-25T10:11:36Z | |
dc.identifier.issn | 0012-186X | |
dc.description | This is the author accepted manuscript. The final version is available from Springer via the DOI in this record. | en_GB |
dc.description | Data availability:
The datasets analysed during the current study are available through application to the
Peninsula Research Bank, which is managed by the NIHR Exeter Clinical Research Facility.
Information on application or data is available on
http://exeter.crf.nihr.ac.uk/content/tissue-banks | en_GB |
dc.identifier.journal | Diabetologia | en_GB |
dc.rights.uri | http://www.rioxx.net/licenses/all-rights-reserved | en_GB |
dcterms.dateAccepted | 2019-02-22 | |
exeter.funder | ::National Institute for Health Research (NIHR) | en_GB |
exeter.funder | ::European Foundation for the Study of Diabetes | en_GB |
rioxxterms.version | AM | en_GB |
rioxxterms.licenseref.startdate | 2019-02-22 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-02-25T10:08:43Z | |
refterms.versionFCD | AM | |
refterms.dateFOA | 2019-05-01T15:19:45Z | |
refterms.panel | A | en_GB |