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[Non classical subtypes of diabetes mellitus].
V Raddatz1, P Durruty, G Briones
1Unidad de Diabetes y Servicio de Urgencia Hospital San Juan de Dios, Servicio de Urgencia Posta Central, Departamento de Endocrinología y Metabolismo, Hospital San Borja Arriarán, Santiago de Chile.
Revista Medica De Chile
|October 30, 2001
Summary
Not all patients experiencing severe diabetic ketoacidosis have type 1 diabetes. Some adults with non-classical diabetes may have latent type 1 or atypical type 2 diabetes, requiring different management strategies.
Area of Science:
- Endocrinology
- Immunology
- Genetics
Background:
- Some adult, obese, and diabetic patients present with severe diabetic ketoacidosis without a clear precipitating factor.
- These patients are often classified as having "non-classical" diabetes mellitus and may not require insulin therapy.
- This presentation can be misleading, as it does not always align with typical type 1 or type 2 diabetes classifications.
Purpose of the Study:
- To investigate the clinical, immunological, genetic, and metabolic characteristics of patients diagnosed with non-classical diabetes mellitus.
- To differentiate between potential underlying causes of severe ketoacidosis in non-classical diabetes.
- To inform diagnostic and therapeutic approaches for this patient subgroup.
Main Methods:
- Studied ten patients (9 men, aged 45 ± 12 years) with non-classical diabetes mellitus.
- Assessed autoantibodies (islet cell and anti-GAD), HLA DQ alpha and beta genotypes.
- Measured insulin secretion (C-peptide post-glucagon) and insulin sensitivity using the minimal model.
Main Results:
- Three patients were classified as latent type 1 diabetes, showing positive autoantibodies and type 1 genetics, with impaired glucose response but preserved C-peptide secretion.
- Seven patients were classified as atypical type 2 diabetes, negative for autoantibodies, with variable insulin secretion and insulin resistance.
- One patient in the type 2 group was found to be insulin sensitive, highlighting heterogeneity within this subgroup.
Conclusions:
- Severe diabetic ketoacidosis at onset does not exclusively indicate type 1 diabetes.
- Non-classical diabetes can encompass latent type 1 diabetes or atypical presentations of type 2 diabetes.
- Accurate classification based on immunological, genetic, and metabolic profiles is crucial for appropriate patient management.