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Diabetes Metab Res Rev. 2017 Oct;33(7). doi: 10.1002/dmrr.2907. Epub 2017 Jun 28.

Clinical heterogeneity of type 1 diabetes (T1D) found in Asia.

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Department of Pediatrics, Pediatric Research Institute, University of Louisville, Louisville, KY, USA.
College of Medicine and Engineering, Hanyang University, Seoul, South Korea.
Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
Wendy Novak Diabetes Care Center, Kosair Children's Hospital, University of Louisville, Louisville, KY, USA.
Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China.


Diabetes mellitus among young patients in Asia is caused by a complex set of factors. Although type 1 diabetes (T1D) remains the most common form of diabetes in children, the recent unabated increase in obesity has resulted in the emergence of type 2 diabetes (T2D) as a new type of diabetes among adolescents and young adults. In addition to the typical autoimmune type 1 diabetes (T1aD) and T2D patients, there is a variable incidence of cases of non-autoimmune types of T1D associated with insulin deficiency (T1bD). Additional forms have been described, including fulminant T1D (FT1D). Although most diagnoses of T1D are classified as T1aD, fulminant T1D exists as a hyper-acute subtype of T1D that affects older children, without associated autoimmunity. Patient with this rare aetiology of diabetes showed a complete loss of β-cell secretory capacity without evidence of recovery, necessitating long-term treatment with insulin. In addition, latent autoimmune diabetes in adults is a form of autoimmune-mediated diabetes, usually diagnosed during the insulin-dependent stage that follows a non-insulin requiring phase, which can be diagnosed earlier based on anti-islet autoantibody positivity. Some reports discuss T1bD. Others are elaborating on the presence of "atypical T1b diabetes," such as Flatbush diabetes. The prevalence of diabetes mellitus in young adults continues to rise in Asian populations as T2D increases. With improved characterization of patients with diabetes, the range of diabetic subgroups will become even more diverse in the future. Distinguishing T1D, T2D, and other forms of diabetes in young patients is challenging in Asian populations, as the correct diagnosis is clinically important and has implications for prognosis and management. Despite aetiological heterogeneity in the usual clinical setting, early diagnosis and classification of patients with diabetes relying on clinical grounds as well as measuring islet autoantibodies and fasting plasma C-peptide could provide a possible viable method to minimize complications.


atypical diabetes; autoantibodies; heterogeneity; type 1 diabetes

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