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Non-immune-mediated versus immune-mediated type 1 diabetes: diagnosis and long-term differences-retrospective analysis

Abstract

Background: The American Diabetes Association proposed two subcategories for type 1 diabetes mellitus: type 1A or immune-mediated diabetes (IDM) and type 1B or idiopathic diabetes. The absence of β-cell autoimmune markers, permanent insulinopenia and prone to ketoacidosis define the second category, whose pathogenesis remains unclear. Only a minority of patients fall into this category, also designated non-immune-mediated (NIDM), which is considered by several authors similar to type 2 diabetes. The aim of this study is to evaluate differences at the diagnosis and 10 years later of two categories. Methods: Retrospective cohort study of patients with β-cell autoimmune markers performed at diagnosis and undetectable c-peptide. Were excluded patients with suspicion of another specific type of diabetes. We obtained two groups: IDM (≥ 1 positive antibody) and NIDM (negative antibodies). Age, family history, anthropometry, duration of symptoms, clinical presentation, blood glucose at admission, A1C, lipid profile, arterial hypertension, total diary insulin dose (TDID), microvascular and macrovascular complications were evaluated. Results were considered statistically significant with p < 0.05. Results: 37 patients, 29 with IDM and 8 patients with NIDM. The age of diagnosis of IDM group (23 years) was significantly different (p = 0.004) from the NIDM group (38.1). The body mass index (BMI) at the diagnosis did not differ significantly (p = 0.435). The duration of symptoms was longer in the NIDM (p = 0.003). The disease presentation (p = 0.744), blood glucose (p = 0.482) and HbA1c (p = 0.794) at admission and TDID at discharge (p = 0.301) did not differ significantly. Total and LDL cholesterol levels were higher in NIDM group but did not differ significantly (p = 0.585 and p = 0.579, respectively). After 10 years BMI did not differ between groups (p = 0.079). Patients with IDM showed a significantly higher HbA1c (p = 0.008) and TDID (p = 0.017). Relative to the lipid profile, there was no significant difference, however the LDL cholesterol and triglycerides were higher on the NIDM group, as the percentage of hypertension. Microvascular complications were higher in the IDM group, but no significant difference was found. Conclusion: Patients with IDM had a poor metabolic control and higher insulin requirement. Patients with NIDM were older and showed higher cardiovascular risk, resembling a clinical phenotype of type 2 diabetes.

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Non-immune-mediated versus immune-mediated type 1 diabetes: diagnosis and long-term differences-retrospective analysis

Author: Catarino, Diana,Silva, Diana,Guiomar, Joana,Ribeiro, Cristina,Ruas, Luísa,Cardoso, Luís,Paiva, Isabel
Publisher: Springer Nature
Year: 2020
DOI: 10.1186/s13098-020-00563-x
Source: https://estudogeral.uc.pt/bitstream/10316/105886/1/Nonimmunemediated-versus-immunemediated-type-1-diabetes-Diagnosis-and-longterm-differences--Retrospective-analysisDiabetology-and-Metabolic-Syndrome.pdf
Ca a inoe al. Diabe ol Me ab Synd (2020) 12:56
h ps://doi.o g/10.1186/s13098-020-00563-x
RESEARCH
Non-immune-media ed
e susimmune-media ed ype 1 diabe es:
diagnosis andlong- e m di e ences—
e ospec i e analysis
Diana Ca a ino1*†, Diana Sil a1*†, Joana Guioma 1, C is ina Ribei o1, Luísa Ruas1, Luís Ca doso1,2
and Isabel Pai a1
Abs ac
Backg ound: The Ame ican Diabe es Associa ion p oposed wo subca ego ies o ype 1 diabe es melli us: ype 1A
o immune-media ed diabe es (IDM) and ype 1B o idiopa hic diabe es. The absence o β-cell au oimmune ma k-
e s, pe manen insulinopenia and p one o ke oacidosis de ine he second ca ego y, whose pa hogenesis emains
unclea . Only a mino i y o pa ien s all in o his ca ego y, also designa ed non-immune-media ed (NIDM), which is
conside ed by se e al au ho s simila o ype 2 diabe es. The aim o his s udy is o e alua e di e ences a he diagno-
sis and 10 yea s la e o wo ca ego ies.
Me hods: Re ospec i e coho s udy o pa ien s wi h β-cell au oimmune ma ke s pe o med a diagnosis and
unde ec able c-pep ide. We e excluded pa ien s wi h suspicion o ano he speci ic ype o diabe es. We ob ained wo
g oups: IDM (≥ 1 posi i e an ibody) and NIDM (nega i e an ibodies). Age, amily his o y, an h opome y, du a ion o
symp oms, clinical p esen a ion, blood glucose a admission, A1C, lipid p o ile, a e ial hype ension, o al dia y insu-
lin dose (TDID), mic o ascula and mac o ascula complica ions we e e alua ed. Resul s we e conside ed s a is ically
signi ican wi h p < 0.05.
Resul s: 37 pa ien s, 29 wi h IDM and 8 pa ien s wi h NIDM. The age o diagnosis o IDM g oup (23 yea s) was
signi ican ly di e en (p = 0.004) om he NIDM g oup (38.1). The body mass index (BMI) a he diagnosis did no
di e signi ican ly (p = 0.435). The du a ion o symp oms was longe in he NIDM (p = 0.003). The disease p esen a-
ion (p = 0.744), blood glucose (p = 0.482) and HbA1c (p = 0.794) a admission and TDID a discha ge (p = 0.301) did
no di e signi ican ly. To al and LDL choles e ol le els we e highe in NIDM g oup bu did no di e signi ican ly
(p = 0.585 and p = 0.579, espec i ely). A e 10 yea s BMI did no di e be ween g oups (p = 0.079). Pa ien s wi h IDM
showed a signi ican ly highe HbA1c (p = 0.008) and TDID (p = 0.017). Rela i e o he lipid p o ile, he e was no signi i-
can di e ence, howe e he LDL choles e ol and iglyce ides we e highe on he NIDM g oup, as he pe cen age o
hype ension. Mic o ascula complica ions we e highe in he IDM g oup, bu no signi ican di e ence was ound.
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Open Access
Diabe ology &
Me abolic Synd ome
*Co espondence: [email p o ec ed]; diana [email p o ec ed]
†Diana Ca a ino and Diana Sil a con ibu ed equally o his wo k
1 Endoc inology, Diabe es and Me abolism Depa men , Cen o
Hospi ala e Uni e si á io de Coimb a EPE, P ace a P o . Mo a Pin o,
3000-075 Coimb a, Po ugal
Full lis o au ho in o ma ion is a ailable a he end o he a icle
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Ca a inoe al. Diabe ol Me ab Synd (2020) 12:56
Backg ound
In 1997, he Ame ican Diabe es Associa ion p oposed
wo subca ego ies o ype 1 diabe es melli us: ype 1A
o immune-media ed diabe es and ype 1B o idiopa hic
diabe es [1, 2].
The immune-media ed diabe es (IDM) esul s om a
cellula au oimmune des uc ion o he β-cells o he pan-
c eas, media ed by T-cells [3, 4]. Ma ke s o he immune
des uc ion o he β-cell include isle cell au oan ibodies,
insulin au oan ibodies, GAD (GAD65) au oan ibodies
and y osine phospha ase (IA2) au oan ibodies. The e is
li le o no insulin sec e ion, mani es ed by low o unde-
ec able le els o plasma C-pep ide [4], and exogenous
insulin is necessa y o p ese e li e. Insulin esis ance
does no play a majo ole in i s pa hogenesis [3]. The
disease has s ong HLA (human leukocy e an igen) hap-
lo ypes associa ions, wi h linkage o he DQA and DQB
genes. The IDM commonly occu s in childhood and
adolescence, bu i can occu a any age and pa ien s a e
a ely obese a he diagnosis [4].
The idiopa hic diabe es is cha ac e ized by absence o
β-cell au oimmune ma ke s, wi h pe manen insulinope-
nia and p one o ke oacidosis [1, 2, 4]. The au ho s o his
pape e oked his ype o diabe es by non-immune-medi-
a ed diabe es melli us (NIDM).
Only a mino i y o pa ien s wi h ype 1 diabe es mel-
li us all in o his subca ego y, howe e i is being ecog-
nized as an impo an clinical en i y [5].
NIDM has been mos ly desc ibed in A ican-Ame -
ican and Asian pa ien s, e en hough i has also been
desc ibed in na i e Ame icans and in Eu opean Medi e -
anean indi iduals [1–3].
Al hough pa ien s wi h NIDM ha e gene ally an onse
simila o ha o pa ien s wi h IDM, some di e ences a e
equen ly ound.
NIDM is cha ac e ized by acu e onse o se e e hype -
glycemia wi h ke oacidosis, equi ing hospi al admis-
sion and ea men wi h insulin and luid and elec oly e
eplacemen [5]. Insulin he apy is gene ally necessa y
o a pe iod going om 6 o 18mon hs, wi h subsequen
good con ol o disease jus wi h o al agen s and die [2].
Recu en ke oacidosis is unusual [5].
NIDM shows a di e en pheno ype, a e mo e o en
male, middle aged, o e weigh , o modes ly obese (obe-
si y class I). They ha e a amily his o y o ype 2 diabe-
es [2, 3, 5, 6]. Due o he p esence o some me abolic
ea u es o ype 2 diabe es, he NIDM has also been
e e ed in he li e a u e as a ypical diabe es, ype 1.5 dia-
be es, Fla bush diabe es and ke osis-p one diabe es [5,
7–9].
I s pa hogenesis is unknown, and he in o ma ion abou
his is sca e, bu is likely ela ed o insulin esis ance and
ansien β-cell dys unc ion, pe haps due o gluco oxic-
i y and lipo oxici y mechanisms [2, 3, 10]. HLA- ela ed
genes a e no belie ed o be in ol ed in i s pa hogenesis,
e en hough mu a ions in di e en genes om HLA ha e
been epo ed, sugges ing ha NIDM may ha e a speci ic
gene ic backg ound.
Recen ly, a he Classi ica ion o diabe es melli us 2019
o he Wo ld Heal h O ganiza ion, he NIDM was eclas-
si ied as ke osis-p one ype 2 diabe es [11].
Me hods
This s udy was app o ed by he local e hics e iew boa ds
(Coimb a Hospi al and Uni e si y Cen e ). All Pa ien s
signed an in o med consen o he scien i ic use o hei
da a.
Re ospec i e coho s udy, om Janua y 2003 o
Decembe 2008, based on clinical eco ds o pa ien s
wi h low C-pep ide (< 0.5ng/mL) and in which diabe-
es melli us- ela ed au oimmune ma ke s (an i GAD-65,
an i-isle s, an i-insulin, an i IA2) we e measu ed. Only
pa ien s whose assays we e pe o med a he ime o
diagnosis o diabe es melli us we e conside ed o ensu e
he inclusion o pa ien s wi h ype 1 DM. O hese, we
ob ained wo g oups: one wi h posi i e au oimmuni y—
IDM g oup (≥ 1 posi i e an ibody) and ano he wi h neg-
a i e au oimmuni y—NIDM g oup. Di e ences be ween
g oups a diagnosis we e e alua ed wi h ega d o age
o diagnosis, amily his o y, an h opome y, du a ion o
symp oms, clinical p esen a ion o disease, plasma glu-
cose a hospi al admission, HbA1c, lipid p o ile, a e ial
hype ension and o al daily insulin dose (TDID).
The au ho s also analyzed di e ences be ween he
g oups a long e m ollow-up- en yea s—wi h ega d
o an h opome y, HbA1c, lipid p o ile, a e ial hype -
ension, TDID, mic o ascula and mac o ascula
complica ions.
C-pep ide measu emen was pe o med a e co ec-
ion o ke osis o ke oacidosis and s abiliza ion o plasma
glucose le els. The lipid p o ile was ob ained in he i s
medical e alua ion a e discha ge.
Conclusion: Pa ien s wi h IDM had a poo me abolic con ol and highe insulin equi emen . Pa ien s wi h NIDM
we e olde and showed highe ca dio ascula isk, esembling a clinical pheno ype o ype 2 diabe es.
Keywo ds: Non-immune-media ed diabe es melli us, Immune-media ed diabe es melli us, Dyslipidemia, To al daily
insulin dose, Mic o ascula complica ions, mac o ascula complica ions
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Ca a inoe al. Diabe ol Me ab Synd (2020) 12:56
In his s udy, all pa ien s included we e ea ed wi h
con en ional basal-bolus he apy.
All pa ien s we e Caucasian.
Ca ego ical a iables a e p esen ed as equencies and
pe cen ages, and con inuous a iables as means and
s anda d de ia ions, o medians and in e qua ile anges
o a iables wi h skewed dis ibu ions. No mal dis i-
bu ion was checked using skewness and ku osis. All
epo ed p alues a e wo- ailed, wi h a p alue o 0.05
indica ing s a is ical signi icance.
The di e ences be ween g oups we e de ec ed by he
S uden ’s es o con inuous a iables wi h no mal dis-
ibu ion, by he Mann–Whi ney es and Wilcoxon es
o con inuous a iables wi hou no mal dis ibu ion and
by he χ2 es o ca ego ical a iables.
Analyses we e pe o med wi h he use o SPSS .25.
Resul s
Di e ences a diagnosis
A diagnosis, 29 pa ien s (78.4%) had posi i e au oim-
mune ma ke s and 8 had nega i e au oimmune ma k-
e s. In he g oup wi h posi i e au oimmuni y,15 pa ien s
we e emale (48.3%), while in he g oup wi h nega i e
au oimmuni y hey we e all male.
In he IDM g oup, he median age o pa ien s a diag-
nosis was 23.0 (9) yea s, and in he NIDM g oup he
mean age a diagnosis was 38.1 ± 12.8yea s, wi h a s a is-
ically signi ican di e ence (p = 0.004).
BMI a diagnosis did no di e signi ican ly (p = 0.435)
be ween he wo g oups (20.97kg/m2 in IDM s 20.37kg/
m2 in NIDM). The e was no s a is ically signi ican asso-
cia ion be ween g oups and amily his o y o ype 1 DM
(p = 0.999) o ype 2 DM (p = 0.999).
Symp oms du a ion in bo h pa ien g oups was s a-
is ically di e en (p = 0.003), wi h a du a ion o
21.8 ± 8.8days in he IDM g oup s 45.0 (60) days in he
NIDM g oup, bu he e was no s a is ically signi ican
associa ion be ween he g oups and he clinical p esen a-
ion o he disease (p = 0.744).
Plasma glucose a hospi al admission was no s a-
is ically di e en (25.47mmol/L in he IDM g oup s
23.92 mmol/L in he NIDM g oup) (p = 0.482), such
as HbA1c a diagnosis (11.3% s 11.8%, espec i ely)
(p = 0.794).
Wi h ega d o lipid p o ile, o al-choles e ol, LDL-C,
HDL-C and iglyce ides le els, hey did no di e sig-
ni ican ly be ween he wo g oups (p = 0.585, p = 0.579,
p = 0.833 and p = 0.555, espec i ely), al hough o al-
choles e ol and LDL-C le els we e highe in he NIDM
g oup. The pe cen age o pa ien s wi h dyslipidemia was
highe in he NIDM g oup (25% s 24.1%), howe e he
di e ence was no s a is ically signi ican (p = 0.999).
Wi h ega d o a e ialhype ension, he e was no signi -
ican di e ence be ween he g oups (p = 0.999).
The TDID a discha ge was no s a is ically di e en
(46.4 uni s s. 40.1 uni s) (p = 0.301) (Table1).
Di e ences a 10yea s o  ollow‑up
A en yea s e alua ion, BMI was no s a is ically di e -
en (p = 0.079) be ween he wo g oups (25.14kg/m2 in
IDM g oup s 22.58kg/m2 in NIDM).
Rela i e o HbA1c he e was s a is ically signi ican
di e ence be ween he g oups (p = 0.008), wi h 8.7% o
IDM g oup and 7.4% o NIDM g oup.
The insulin equi emen was also s a is ically di e -
en . The TDID o he IDM g oup was 52.35 uni s and he
NIDM g oup was 33.5 uni s (p = 0.017).
The pe cen age o pa ien s wi h dyslipidemia was
highe in he NIDM g oup (62.5% s 44.8%), howe e he
di e ence was no s a is ically signi ican (p = 0.999).
Wi h ega d o lipid p o ile, o al-choles e ol, LDL-C,
HDL-C and iglyce ides le els he e was no s a is ically
signi ican di e ence be ween he wo g oups (p = 0.728,
p = 0.571, p = 0.338, p = 0.648, espec i ely), howe e he
LDL-C and iglyce ides le els we e highe in he NIDM
g oup.
The pe cen age o pa ien s wi h hype ension was
highe in he NIDM g oup (25% s 17.2%), al hough
he e was no signi ican di e ence be ween he g oups
(p = 0.999).
Wi h ega d o mic o ascula complica ions, he e was
no s a is ically signi ican di e ence a he pe cen age o
e inopa hy, neu opa hy and neph opa hy be ween he
wo g oups (p = 0.550, p = 0.550, p = 0.550, espec i ely)
bu he pe cen age was highe in he IDM g oup. A
10yea s ollow-up, he NIDM g oup had no mic o as-
cula complica ions.
The e was no signi ican di e ence on he mac o ascu-
la disease oo (Table2).
Discussion andconclusions
Ou s udy sugges s ha he NIDM may be de ec ed
among subjec s o Caucasian e hnici y and in spi e o ini-
ial clinical p esen a ion compa ible wi h IDM, hey di e
a diagnosis in e ms o au oimmune ma ke s, sex, age o
pa ien s and symp oms du a ion.
All pa ien s in he NIDM g oup included in ou s udy
we e men, epo ing a male p edominance consis en
wi h o he s udies [1–3, 12] So a , he cause o his male
p edominance is unknown, howe e i is hough ha
ho monal ac o s may be in ol ed.
In he IDM g oup, he median age o pa ien s a diag-
nosis was highe , in ag eemen wi h o he s udies [1, 7,
13].
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Ca a inoe al. Diabe ol Me ab Synd (2020) 12:56
Symp oms du a ion in bo h pa ien g oups was s a-
is ically di e en , wi h a longe du a ion in he NIDM
g oup, unlike o he s udies, in which he e we e no di e -
ences be ween he wo g oups [1].
BMI a diagnosis did no di e signi ican ly be ween
he wo g oups. In mos p e ious s udies, pa ien s in he
NIDM g oup ha e a highe BMI wi h isce al obesi y,
esembling pa ien s wi h ype 2 diabe es [1, 2].
The e was no s a is ically signi ican associa ion in he
clinical p esen a ion o he disease, as in p e ious s ud-
ies [3, 7, 12], making some imes di icul o di e en ia e i
wi h he IDM g oup.
HbA1c a diagnosis and he TDID a discha ge we e
no s a is ically di e en be ween he wo g oups, which
is in ag eemen wi h o he wo ks [1, 2]. To al-choles-
e ol and LDL-C le els we e highe in he NIDM g oup,
as p e iously epo ed in o he s udies, whe e pa ien s
om his g oup ha e a mo e a he ogenic lipid p o ile, as
pa ien s wi h ype 2 diabe es [2].
A a long- e m e alua ion, ou s udy shows ha
pa ien s wi h IDM had a poo me abolic con ol, wi h
highe HbA1c and highe insulin equi emen , consis -
en wi h p e ious s udies [2]. On he o he hand, in he
NIDM g oup he e was a highe HbA1c educ ion wi h
lowe insulin equi emen .
In ac , o he s udies epo ed a se e e insulin sec e o y
de iciency only du ing he acu e ke o ic phase in pa ien s
wi h NIDM wi h a clinical emission phase co ela ed o
an insulin sec e ion eco e y [2].
Pa ien s wi h NIDM showed a lowe  endency o
mic o ascula complica ions, like ype 2 diabe es. Mic o-
ascula complica ions we e mo e equen in he IDM
g oup.
Pa ien s wi h NIDM showed, as a he diagnosis, a ypi-
cal a he ogenic lipid p o ile, cha ac e ized a 10yea s by
high LDL-choles e ol and iglyce ides le els. This g oup
also showed a highe p opo ion o a e ialhype ension
pa ien s. So, he au ho s concluded ha NIDM is associ-
a ed wi h highe ca dio ascula isk han IDM since he
diagnosis.
The e a e some limi a ions o his s udy, ha should be
men ioned, such as he sample size ha was condi ioned
by he e ospec i e na u e o he s udy. The au ho s we e
limi ed o pa ien s whose assays we e made a diagnosis
o a oid misdiagnosis.
In conclusion, ecogni ion o he NIDM ca ego y is
c i ical in clinical p ac ice because i may modi y he
he apeu ic app oach o hese pa ien s, in he mid and
long e m. This en i y was ini ially diagnosed in Asian
and A ican Ame ican popula ions, howe e , indi iduals
om o he e hnic g oups, namely Caucasian, ha e been
Table 1 Clinical andme abolic pa ame e s inpa ien s wi hIDM andNIDM a diagnosis
SD: s anda d de ia ion; IQR: in e qua ile ange
p* < 0.05: s a is ically signi ican di e ence
P esen a ion o he disease: diabe ic ke oacidosis; hype glycemic hype osmola synd ome; polyu ic polydipsic synd ome; diabe ic ke oacidosis wi h hype osmola i y;
seizu es
IDM g oup
(n = 29; 78.4%)
Mean ± SD
Median (IQR)
NIDM g oup
(n = 8; 21.6%)
Mean ± SD
Median (IQR)
p alue
Clinical pa ame e s
Age (yea s) 23.0 (9) 38.1 ± 12.8 0.004*
BMI (Kg/m2) 20.97 (3.5) 20.37 ± 2.7 0.435
Family his o y ype 1/2 DM (%) 17.2/37.9 12.5/37.5 0.999
Symp oms du a ion (days) 21.8 ± 8.8 45.0 (60) 0.003*
P esen a ion o he disease 0.744
A e ial hype ension (%) 6.9 0 0.999
Me abolic pa ame e s
Plasma glucose a admission (mmol/L) 25.47 (8.16) 23.92 (8.66) 0.482
HbA1c (%) 11.3 ± 2.2 11.8 (2.5) 0.794
TDID (U) 46.4 ± 15.3 40.1 ± 12.3 0.301
Dyslipidemia (%) 24.1 25.0 0.999
To al-C (mmol/L) 8.77 (2.61) 9.05 (2.72) 0.585
LDL-C (mmol/L) 5.57 ± 1.44 5.90 ± 1.47 0.579
HDL-C (mmol/L) 2.75 ± 0.83 2.80 (0.50) 0.833
T iglyce ides (mmol/L) 4.73 (1.37) 3.72 (2.05) 0.555
Page 5 o 6
Ca a inoe al. Diabe ol Me ab Synd (2020) 12:56
inc easingly iden i ied. The ini ial clinical p esen a ion
is simila o he IDM g oup, equi ing in ensi e ini ial
insulin he apy and luid and elec oly e eplacemen .
Howe e , behind he gluco oxici y and lipo oxici y phase,
he e is unc ional eco e y o he β cell a e se e al
weeks, which allows in mos pa ien s an app oach wi h
die alone o die plus o al medica ions.
The pa hophysiological mechanisms leading o he
acu e onse o se e e hype glycemia, wi h o wi h-
ou ke osis and ke oacidosis in suscep ible pa ien s a e
unknown; hence u he in es iga ion in his a ea is
needed.
The ecogni ion o NIDM pa ien s is also c ucial
because hey a e exposed o a highe ca dio ascula
isk needing adequa ed ea men o educe he long-
e mca dio ascula complica ions.
Abb e ia ions
DM: Diabe es melli us; NIDM: Non-immune-media ed diabe es melli us;
IDM: Immune-media ed diabe es melli us; TDID: To al daily insulin dose; HLA:
Human leukocy e an igen; GAD: Glu amic acid deca boxylase.
Acknowledgemen s
No applicable.
Au ho s’ con ibu ions
DC and DS has p oduced he epo and li e a u e e iew. CR, JG and LR
assis ed in he p oduc ion o he a icle and he li e a u e e iew. IP and LC
o e saw he c ea ion o he manusc ip . All au ho s ead and app o ed he
inal manusc ip .
Funding
This esea ch did no ecei e any speci ic g an om unding agencies in he
public, comme cial, o no - o -p o i sec o s.
A ailabili y o da a and ma e ials
All da a gene a ed o analysed du ing his s udy a e included in his published
a icle.
E hics app o al and consen o pa icipa e
This s udy was app o ed by he local e hics e iew boa ds (Coimb a Hospi al
and Uni e si y) and all pa icipan s signed he consen o use hei da a o
scien i ic pu pose.
Consen o publica ion
I was ob ained om all he pa icipan s included.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Au ho de ails
1 Endoc inology, Diabe es and Me abolism Depa men , Cen o Hospi ala
e Uni e si á io de Coimb a EPE, P ace a P o . Mo a Pin o, 3000-075 Coimb a,
Po ugal. 2 Medicine Facul y o Coimb a Uni e si y, Coimb a, Po ugal.
Recei ed: 30 Janua y 2020 Accep ed: 25 June 2020
Re e ences
1. Aguile a E, Casami jana R, E cilla G, e al. Adul -onse a ypical ( ype 1)
diabe es: addi ional insigh s and di e ences wi h ype 1A diabe es in a
Eu opean Medi e anean popula ion. Diabe es Ca e. 2004;27:1108–14.
2. Gua no a V, Vigne i E, Pilli e i G, e al. Highe ca diome abolic isk in
idiopa hic e sus au oimmune ype 1 diabe es: a e ospec i e analysis.
Diabe ol Me ab Synd . 2018;10:40.
3. Piñe o-Piloña A, A ilés-San a L, Lin onjua P, e al. Idiopa hic ype 1 diabe-
es in Dallas, Texas. Diabe es Ca e. 2001;24:1014–8.
Table 2 Clinical and me abolic pa ame e s in pa ien s
wi hIDM andNIDM a 10yea s o  ollow-up
SD: s anda d de ia ion; IQR: in e qua ile ange; NA: no applicable
p* < 0.05: s a is ically signi ican di e ence
We ound a educ ion in HbA1C a 10yea s o ollow-up in bo h g oups
[2.4 ± 2.6% in he IDM g oup; 3.9 (4.0) % in he NIDM g oup]. The HbA1C
educ ion was highe in he NIDM g oup, al hough i did no di e signi ican ly
(p = 0.109). Wi h ega d o he a ia ion o he TDID, he IDM g oup had a highe
need o insulin a 10yea s compa ed o he diagnosis (52.4 ± 16.7U a 10yea s
e sus 46.4 ± 15.3U a diagnosis), unlike he NIDM g oup [33, 5 (12) U a 10yea s
e sus 40.1 ± 12.3 U a diagnosis] (Table3)
IDM g oup
(n = 29; 78.4%)
Mean ± SD
Median (IQR)
NIDM g oup
(n = 8; 21.6%)
Mean ± SD
Median (IQR)
p alue
Clinical pa ame e s
BMI (Kg/m2) 25.1 (4.2) 22.6 ± 3.5 0.079
A e ial hype ension (%) 17.2 25.0 0.999
Me abolic pa ame e s
HbA1c (%) 8.7 (1.7) 7.4 (1.0) 0.008*
TDID (U) 52.4 ± 16.7 33.5 (12) 0.017*
Dyslipidemia (%) 44.8 62.5 0.999
To al-C (mmol/L) 185.7 ± 43.2 184 (112) 0.728
LDL-C (mmol/L) 108.5(51) 112 (89) 0.571
HDL-C (mmol/L) 58.1 ± 13.7 58.4 ± 13.0 0.338
T iglyce ides (mmol/L) 79(51) 83 (169) 0.648
Long e m complica ions
Mic o ascula complica-
ions
Re inopa hy 13.8 0 0.550
Neu opa hy 10.3 0 0.550
Neph opa hy 10.3 0 0.550
Mac o ascula complica-
ions
Co ona y disease 0 12.5 0.250
Ce eb o ascula disease 3.4 0 0.999
Pe iphe al a e ial
disease 0 0 NA
Table 3 O e - ime a ia ion o  HbA1c be ween IDM
andNIDM g oups
SD: s anda d de ia ion; IQR: in e qua ile ange
p* < 0.05: s a is ically signi ican di e ence
IDM g oup
(n = 29; 78.4%)
Mean ± SD
Median (IQR)
NIDM g oup
(n = 8; 21.6%)
Mean ± SD
Median (IQR)
p
HbA1c (%) 2.4 ± 2.6 3.9 ± 4.0 0.109

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lished maps and ins i u ional a ilia ions.