Evaluation of the new ADA and WHO criteria for classification of diabetes mellitus in young adult people (15-34 yrs) in the Diabetes Incidence Study in Sweden (DISS)

• Published in: Diabetologia 2003-02, Vol.46 (2), p.173-181
• Main Authors: BORG, H, ARNQVIST, H. J, BJÖRK, E, BOLINDER, J, ERIKSSON, J. W, NYSTRÖM, L, JEPPSSON, J.-O, SUNDKVIST, G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Autoantibodies - analysis; Biological and medical sciences; C-Peptide - blood; Clinical Medicine; Diabetes Mellitus - classification; Diabetes Mellitus - epidemiology; Diabetes Mellitus - immunology; Diabetes Mellitus - physiopathology; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - immunology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting - blood; Humans; Incidence; Islets of Langerhans - physiopathology; Klinisk medicin; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Societies, Medical; Sweden - epidemiology; United States; World Health Organization
• ISSN: 0012-186X; 1432-0428; 1432-0428
• DOI: 10.1007/s00125-002-1021-4

We aimed to evaluate how an aetiology-based classification, as recommended in the ADA and WHO guidelines for classification of diabetes mellitus, matches clinical judgement in the Diabetes Incidence Study in Sweden (DISS), a study covering incident cases of diabetic patients aged 15 to 34 years. During a 1-year period (1998), blood samples were taken at diagnosis and 4 months (median) thereafter. Patients were classified according to clinical judgement by the reporting physicians and assessments of islet antibodies (ICA, GADA, and IA-2A) and plasma C-peptide. In 1998, 422 patients were registered in DISS. Among the 313 patients participating in the follow-up, most with clinical Type 1 diabetes (185/218, 85%, 95% CI 79-89%) were islet antibody positive (ab+) at diagnosis. In addition, 14 out of 58 (24%, 14-37%) with clinical Type 2 diabetes and 21 out of 37 (57%, 40-73%) with unclassifiable diabetes were antibody positive at diagnosis. Further to this, 4 out of 33 (12%, 3-28%) were antibody negative with clinical Type 1 diabetes and 4 out of 44 (9%, 3-22%) with Type 2 had converted to antibody positive at follow-up. Among those who were constantly antibody negative, 10 out of 29 (34%, 18-54%) with clinical Type 1 and 1 out of 16 (6%, 0-30%) with unclassifiable diabetes had fasting plasma C-peptide concentrations below the normal range (