Diabetes Forecast

Diabetes Diagnosis Strategies

By Henry Rodriguez, MD, Associate Editor ,

Advances in testing and therapy may soon dramatically change the way that people are diagnosed with diabetes.

Until now, it hasn't always been crucial for doctors to differentiate between type 1 and type 2 when diagnosing someone as having diabetes. With children, care providers have generally initiated insulin therapy at diagnosis based upon blood glucose levels, not worrying at first whether it's type 1 or type 2. Adults, on the other hand, are typically prescribed oral medications and then started on insulin if their blood glucose goals cannot be met, unless they show clear signs of type 1 diabetes such as diabetic ketoacidosis.

The development of more specific immunotherapy targeting type 1 diabetes will most likely change these approaches. It is now possible, by measuring levels of specific antibodies in the blood, to identify whether someone's diabetes is caused, at least in part, by the immune system's attack on the insulin-producing beta cells; in other words, whether the person has type 1.

Many pediatric diabetes care providers, particularly those at academic centers, already routinely measure levels of these antibodies when children and teens are diagnosed. But such measurements are the exception, not the rule, in caring for adults. Without a safe and effective treatment that targets the immune system, there has been little reason to go to the effort and expense of measuring diabetes autoantibodies in newly diagnosed adults. As a result, a significant number of adults with type 1 diabetes may be misdiagnosed as having type 2.

Numerous clinical research studies are examining the safety and effectiveness of drugs that may slow down or stop the immune system's destruction of the insulin-producing beta cells. In type 1 diabetes, most experts agree that preserving at least some of the body's ability to make insulin allows for better blood glucose control and decreases the risk for low blood glucose (hypoglycemia). The availability of such therapy will require providers to determine whether someone with newly diagnosed diabetes has at least a component of autoimmunity. If so, specific treatment to halt beta-cell destruction can be offered as an option.

Progress in the field of genetics may also lead to future screening for type 1 diabetes in the general population. To date, studies such as Type 1 Diabetes TrialNet have focused screening efforts on those at highest risk: the youngest first- and second-degree relatives of people with the disease. A greater understanding of genetic factors contributing to risk and improved genetic tests may make it cost-effective to screen everyone for the risk of developing type 1 diabetes and other diseases. Those at greatest risk may then consider potential preventive therapies.

With advances such as these, the strategy of diabetes treatment may make a major move, from defense to offense. Stay tuned.



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