Difficulties in Classifying Diabetes at Presentation in the Young Adult

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Abstract
All newly diagnosed diabetic patients in Sweden aged 15–34 years have been registered since 1983. In this study the clinical characteristics initially and after 2.5‐3 years were evaluated by a questionnaire to the patient's physician and by non‐fasting C‐peptide. The study comprised patients registered 1983‐84, and for 281 patients (37%), complete information was obtained. At diagnosis 75% were classified as Type 1, 19% as Type 2, and 6% as secondary diabetes or as uncertain by their physician. Twenty patients (7.1%) were reported to have ketoacidosis. Seventy‐five percent were treated with insulin, 7% with oral hypoglycaemic agents (OHG), and 18% with diet alone. At follow‐up 71% were classified as Type 1, 21% as Type 2, and 8% as secondary or uncertain while treatment was 82% insulin, 8% OHG, and 9% diet. During the follow‐up period 42% of the initially non‐insulin‐treated patients were put on insulin whereas only a few stopped insulin treatment. Patients treated with diet or OHG at follow‐up were older, had higher percent desirable weight, and lower blood glucose at diagnosis than patients treated with insulin. All except one patient had measurable random C‐peptide at follow‐up and mean values were for patients treated with insulin 0.55, OHG 1.41 and diet alone 1.29 nmol I−1. Random blood glucose results were similar. In conclusion the majority of newly diagnosed patients in the age group 15–34 years have the characteristics of Type 1 diabetes and Type 2 diabetes is rare before 25–30 years of age. Patients with biochemically mild hyperglycaemia are difficult to classify and there is a need for new guidelines for classification of diabetes which include aetiopathogenetic aspects.

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