Late-onset T1D is often mislabeled as T2D

  • Thomas NJ & al.
  • Diabetologia
  • 10 Apr 2019

  • International Clinical Digest
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Takeaway

  • Patients with type 1 diabetes (T1D) onset after age 30 years are often diagnosed and treated as having type 2 diabetes (T2D).
  • Clinical characteristics do not always predict type.

Why this matters

  • Misdiagnosis may delay appropriate insulin therapy. 

Study design

  • UK diabetes research population characteristics assessed for those requiring insulin within 3 years of diagnosis and severe endogenous insulin deficiency (nonfasting C-peptide 30 years.
  • Comparison with those with retained endogenous insulin secretion (>600 pmol/L) and 220 with severe insulin deficiency diagnosed at age
  • Funding: Wellcome Trust; Exeter.

Key results

  • Severe insulin deficiency found in 21% of 583 diagnosed with diabetes after age 30 years.
  • Participants with late-onset T1D more likely to have been diagnosed and treated as having T2D (15% vs 5% oral glucose-lowering drug use; 62% vs 96% insulin at diagnosis; 20% vs 0% self-reported T2D).
  • 41% with late-onset T1D had BMI 2, and 28% of those with BMI 2 had T2D.
  • Insulin not given at diagnosis in 38% with late-onset T1D; average was 12 months until receiving it.

Limitations

  • Cross-sectional.
  • Relatively homogeneous, geographically restricted population.
  • Self-reported time to insulin, age at diagnosis.