Unmasking the phenotype of adult-onset type 1 diabetes
Dr Patel added: “Once we discovered the misclassification of type 1 diabetes in our clinically suspected type 1 diabetes study, it became clear that all the previous studies that used the clinical judgment to define type 1 diabetes at diagnosis inadvertently included non-autoimmune diabetes.
“This may have resulted in masking the true phenotype of late-onset type 1 diabetes. Indeed, when we removed the misclassified type 1 diabetes, we uncovered novel biology of late-onset type 1 diabetes and diversity of type 1 diabetes; for example, we found that adult-onset type 1 diabetes has the same rate of positive autoantibodies as children but the pattern of autoantibodies are very different.”
The study concluded: “The high rate of misclassification in adults who are clinically suspected of having type 1 diabetes strongly supports the routine measurement of autoantibodies in all individuals and not just when there is diagnostic uncertainty.”
Dr Patel said: “Our study results have improved our understanding of the late-onset type 1 diabetes which accounts for nearly half of all type 1 diabetes.
“Our results strongly suggest that clinical suspicion is not enough to accurately diagnose type 1 diabetes. Nearly one in five patients who are clinically thought to have late-onset type 1 diabetes (diabetes onset after 30 years of age) actually have type 2 diabetes. We went on and showed that measuring islet autoantibodies, which are easily accessible in routine clinical practice, greatly minimise this misdiagnosis.
“Based on our work, we recommend that all patients, despite the very high clinical suspicion, should have islet autoantibodies to support the clinical diagnosis.
“Our study also provides important new information that adult/late type 1 diabetes is different from childhood-onset diabetes. We showed that people living with adult/late-onset type 1 diabetes have a different combination of islet autoantibodies compared to childhood-onset type 1 diabetes.
“We also showed that nearly 92% of adult/late-onset type 1 diabetes have islet antibodies similar to childhood-onset type 1 diabetes. This has challenged the current understanding that fewer people with adult-onset type 1 diabetes have these antibodies.”
Sarah Tutton, Chief Executive of DRWF, said: “DRWF awarded Dr Patel a Pump Priming award in 2018 to support the implementation of a genetic risk score, as part of a wider body of research that sought to define heterogeneity in patients with clinically diagnosed adult-onset type 1 diabetes using islet autoantibodies and genetics. This work has ultimately identified clinically useful new information about type 1 diabetes which will have a clinical implication in routine clinical care of type 1 diabetes.
“This is a fantastic outcome and just goes to show that relatively small amounts of funding can have a significant impact and result in tangible benefits for diagnosis and treatment of diabetes.”
Read the report in Diabetologia
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