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      Adult-onset autoimmune diabetes: current knowledge and implications for management

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      Journal: Nature Reviews Endocrinology
      Publisher: Springer Nature

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          Abstract

          The clinical and metabolic heterogeneity of adult-onset autoimmune diabetes, which encompasses a spectrum of phenotypes, ranging from classic adult-onset type 1 diabetes mellitus to latent autoimmune diabetes in adults, represents a considerable challenge for the management of this disease. In this Review, the authors summarize the definition, pathophysiology and clinical features of adult-onset autoimmune diabetes and discuss their implications for treatment.

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          Type 1 diabetes: new perspectives on disease pathogenesis and treatment.

          M Atkinson, G S Eisenbarth (2001)
          As our knowledge of type 1 (insulin-dependent) diabetes increases, so does our appreciation for the pathogenic complexity of this disease and the challenges associated with its treatment. Many new concepts about the pathogenesis of this disorder have arisen. The role of genetics versus environment in disease formation has been questioned, and the basis on which type 1 diabetes is characterised and diagnosed is the subject of much debate. Additionally, the care and treatment of patients with type 1 diabetes has seen a rapid evolution; with genetically engineered insulins, glucose monitoring devices, and algorithms all contributing to a decrease in disease-related complications. We focus this seminar on these changing views, and offer a new perspective on our understanding of the pathogenesis of type 1 diabetes and on principles for therapeutic management of patients with this disorder.
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            Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis.

            M Harris, R. Klein, T A Welborn … (1992)
            To investigate duration of the period between diabetes onset and its clinical diagnosis. Two population-based groups of white patients with non-insulin-dependent diabetes (NIDDM) in the United States and Australia were studied. Prevalence of retinopathy and duration of diabetes subsequent to clinical diagnosis were determined for all subjects. Weighted linear regression was used to examine the relationship between diabetes duration and prevalence of retinopathy. Prevalence of retinopathy at clinical diagnosis of diabetes was estimated to be 20.8% in the U.S. and 9.9% in Australia and increased linearly with longer duration of diabetes. By extrapolating this linear relationship to the time when retinopathy prevalence was estimated to be zero, onset of detectable retinopathy was calculated to have occurred approximately 4-7 yr before diagnosis of NIDDM. Because other data indicate that diabetes may be present for 5 yr before retinopathy becomes evident, onset of NIDDM may occur 9-12 yr before its clinical diagnosis. These findings suggest that undiagnosed NIDDM is not a benign condition. Clinically significant morbidity is present at diagnosis and for years before diagnosis. During this preclinical period, treatment is not being offered for diabetes or its specific complications, despite the fact that reduction in hyperglycemia, hypertension, and cardiovascular risk factors is believed to benefit patients. Imprecise dating of diabetes onset also obscures investigations of the etiology of NIDDM and studies of the nature and importance of risk factors for diabetes complications.
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              The many faces of diabetes: a disease with increasing heterogeneity.

              Tiinamaija Tuomi, Nicola Santoro, Sonia Caprio … (2014)
              Diabetes is a much more heterogeneous disease than the present subdivision into types 1 and 2 assumes; type 1 and type 2 diabetes probably represent extremes on a range of diabetic disorders. Both type 1 and type 2 diabetes seem to result from a collision between genes and environment. Although genetic predisposition establishes susceptibility, rapid changes in the environment (ie, lifestyle factors) are the most probable explanation for the increase in incidence of both forms of diabetes. Many patients have genetic predispositions to both forms of diabetes, resulting in hybrid forms of diabetes (eg, latent autoimmune diabetes in adults). Obesity is a strong modifier of diabetes risk, and can account for not only a large proportion of the epidemic of type 2 diabetes in Asia but also the ever-increasing number of adolescents with type 2 diabetes. With improved characterisation of patients with diabetes, the range of diabetic subgroups will become even more diverse in the future. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Title: Nature Reviews Endocrinology
                Abbreviated Title: Nat Rev Endocrinol
                Publisher: Springer Nature
                ISSN (Print): 1759-5029
                ISSN (Electronic): 1759-5037
                Publication date Created: September 8 2017
                Publication date (Print): September 8 2017
                Volume:
                Issue:
                Article
                DOI: 10.1038/nrendo.2017.99
                PubMed ID: 28885622
                SO-VID: a61478d4-dc2d-4b9b-bb65-a07776e283e3
                Copyright © © 2017
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