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Yimaitong compiles and organizes, please do not reprint without authorization
.
Guide: The 2022 version of the ADA Diabetes Diagnosis and Treatment Standards has been released recently (hereinafter referred to as the guideline).
This article discusses the guidelines involved in the "Classification of Diabetes, Type 1 and Type 2 Diabetes Identification Key Points, Type 1 Diabetes Staging, and LADA Controversies".
Compile and organize
.
Diabetes classification-2022 ADA guidelines 2022 ADA guidelines divide diabetes into the following categories: ➤ Type 1 diabetes: due to autoimmune β cell destruction, usually leading to absolute insulin deficiency, including adult latent autoimmune diabetes; ➤ Type 2 diabetes: Usually under the background of insulin resistance, β-cell insulin secretion function is progressively impaired; ➤ Specific types of diabetes caused by other reasons: such as monogenic diabetic syndrome (such as neonatal diabetes and MODY), exocrine pancreatic disease ( Such as cystic fibrosis and pancreatitis), drug or chemical-induced diabetes (such as the use of glucocorticoids in the treatment of HIV/AIDS or after organ transplantation); ➤ Gestational Diabetes (GDM): Diagnosed in the second or third trimester of pregnancy Diabetes
.
Differentiation points: Type 1 diabetes and type 2 diabetes 1.
Type 1 diabetes and type 2 diabetes are easily misdiagnosed as heterogeneous diseases, and clinical manifestations and disease progression are usually very different
.
Accurate classification is important for determining the treatment plan.
However, some patients cannot be clearly classified as type 1 or type 2 diabetes at the time of diagnosis, and misdiagnosis is more common.
For example, adult-onset type 1 diabetes patients are misdiagnosed as type 2 diabetes, and MODY patients are misdiagnosed misdiagnosed as type 1 diabetes
.
Although diabetic patients of all age groups may be difficult to diagnose when they are onset, as time goes by, the lack of beta cells worsens and the diagnosis will become clearer
.
2.
Misunderstandings in diagnosis The traditional concepts of "Type 2 diabetes only occurs in adults" and "Type 1 diabetes only occurs in children" are not accurate, because both age groups may have the disease
.
3.
Differentiation points (clinical manifestations) Children with type 1 diabetes often show the characteristic symptoms of polyuria/polydipsia, and about half of them show diabetic ketoacidosis (DKA)
.
The most effective features for identifying type 1 diabetes include younger age at diagnosis (<35 years), low body mass index (<25 kg/m^2), unexplained weight loss, ketoacidosis, and blood glucose> 20mmol/L when present
.
Note: The onset of type 1 diabetes may be more variable in adults-for example, the typical symptoms of children do not appear, and may be temporarily relieved by the use of insulin
.
A small number of patients with type 2 diabetes may also have DKA, especially ethnic minorities
.
Prediction and staging of type 1 diabetes The basic pathophysiological characteristics of type 1 diabetes are more accurate than type 2 diabetes
.
Currently, prospective studies have shown that the persistence of two or more islet autoantibodies is an almost definite predictor of clinical diabetes
.
The rate of progress depends on the age when autoantibodies are first detected, the number of autoantibodies, autoantibody specificity, and autoantibody titer
.
Blood glucose and A1C levels have been elevated before the onset of diabetes clinically, which allows diagnosis before the onset of DKA
.
The 2022 guideline gives three different stages of type 1 diabetes (Table 1), which can be used as a framework for future research and regulatory decision-making
.
Table 1 Stages of Type 1 Diabetes Note: FPG, fasting blood glucose; IFG, impaired fasting blood glucose; IGT, impaired glucose tolerance; 2-h PG, 2-h blood glucose
.
Adult onset, slow progress-"LADA" or "type 1 diabetes"? When it comes to adult latent autoimmune diabetes (LADA), the first thing to be aware of when testing is that adults can slowly destroy autoimmune β cells, leading to long-term marginal insulin secretion
.
The use of the term "LADA" is very common in clinical practice and is acceptable.
It helps people realize that "progressive autoimmune beta cell destruction exists in adults" and helps before blood sugar control deteriorates or DKA appears Start insulin as early as possible
.
There is controversy as to whether adult-onset slowly progressive autoimmune diabetes should be called LADA or type 1 diabetes
.
However, in the current classification of the ADA guidelines, all forms of diabetes mediated by autoimmune β-cell destruction are included in the category of type 1 diabetes
.
Yimaitong compiled and compiled from: American Diabetes Association Professional Practice Committee.
2.
Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2022.
Diabetes Care 2022;45 (Suppl.
1): S17–S38.
.
Guide: The 2022 version of the ADA Diabetes Diagnosis and Treatment Standards has been released recently (hereinafter referred to as the guideline).
This article discusses the guidelines involved in the "Classification of Diabetes, Type 1 and Type 2 Diabetes Identification Key Points, Type 1 Diabetes Staging, and LADA Controversies".
Compile and organize
.
Diabetes classification-2022 ADA guidelines 2022 ADA guidelines divide diabetes into the following categories: ➤ Type 1 diabetes: due to autoimmune β cell destruction, usually leading to absolute insulin deficiency, including adult latent autoimmune diabetes; ➤ Type 2 diabetes: Usually under the background of insulin resistance, β-cell insulin secretion function is progressively impaired; ➤ Specific types of diabetes caused by other reasons: such as monogenic diabetic syndrome (such as neonatal diabetes and MODY), exocrine pancreatic disease ( Such as cystic fibrosis and pancreatitis), drug or chemical-induced diabetes (such as the use of glucocorticoids in the treatment of HIV/AIDS or after organ transplantation); ➤ Gestational Diabetes (GDM): Diagnosed in the second or third trimester of pregnancy Diabetes
.
Differentiation points: Type 1 diabetes and type 2 diabetes 1.
Type 1 diabetes and type 2 diabetes are easily misdiagnosed as heterogeneous diseases, and clinical manifestations and disease progression are usually very different
.
Accurate classification is important for determining the treatment plan.
However, some patients cannot be clearly classified as type 1 or type 2 diabetes at the time of diagnosis, and misdiagnosis is more common.
For example, adult-onset type 1 diabetes patients are misdiagnosed as type 2 diabetes, and MODY patients are misdiagnosed misdiagnosed as type 1 diabetes
.
Although diabetic patients of all age groups may be difficult to diagnose when they are onset, as time goes by, the lack of beta cells worsens and the diagnosis will become clearer
.
2.
Misunderstandings in diagnosis The traditional concepts of "Type 2 diabetes only occurs in adults" and "Type 1 diabetes only occurs in children" are not accurate, because both age groups may have the disease
.
3.
Differentiation points (clinical manifestations) Children with type 1 diabetes often show the characteristic symptoms of polyuria/polydipsia, and about half of them show diabetic ketoacidosis (DKA)
.
The most effective features for identifying type 1 diabetes include younger age at diagnosis (<35 years), low body mass index (<25 kg/m^2), unexplained weight loss, ketoacidosis, and blood glucose> 20mmol/L when present
.
Note: The onset of type 1 diabetes may be more variable in adults-for example, the typical symptoms of children do not appear, and may be temporarily relieved by the use of insulin
.
A small number of patients with type 2 diabetes may also have DKA, especially ethnic minorities
.
Prediction and staging of type 1 diabetes The basic pathophysiological characteristics of type 1 diabetes are more accurate than type 2 diabetes
.
Currently, prospective studies have shown that the persistence of two or more islet autoantibodies is an almost definite predictor of clinical diabetes
.
The rate of progress depends on the age when autoantibodies are first detected, the number of autoantibodies, autoantibody specificity, and autoantibody titer
.
Blood glucose and A1C levels have been elevated before the onset of diabetes clinically, which allows diagnosis before the onset of DKA
.
The 2022 guideline gives three different stages of type 1 diabetes (Table 1), which can be used as a framework for future research and regulatory decision-making
.
Table 1 Stages of Type 1 Diabetes Note: FPG, fasting blood glucose; IFG, impaired fasting blood glucose; IGT, impaired glucose tolerance; 2-h PG, 2-h blood glucose
.
Adult onset, slow progress-"LADA" or "type 1 diabetes"? When it comes to adult latent autoimmune diabetes (LADA), the first thing to be aware of when testing is that adults can slowly destroy autoimmune β cells, leading to long-term marginal insulin secretion
.
The use of the term "LADA" is very common in clinical practice and is acceptable.
It helps people realize that "progressive autoimmune beta cell destruction exists in adults" and helps before blood sugar control deteriorates or DKA appears Start insulin as early as possible
.
There is controversy as to whether adult-onset slowly progressive autoimmune diabetes should be called LADA or type 1 diabetes
.
However, in the current classification of the ADA guidelines, all forms of diabetes mediated by autoimmune β-cell destruction are included in the category of type 1 diabetes
.
Yimaitong compiled and compiled from: American Diabetes Association Professional Practice Committee.
2.
Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2022.
Diabetes Care 2022;45 (Suppl.
1): S17–S38.
