Key Principles of Differential Diagnosis of Diabetes Mellitus Types in Young Patients
https://doi.org/10.31550/1727-2378-2023-22-4-24-28
Abstract
Aim: To study peculiarities of various types of diabetes mellitus (DM) in young patients.
Key points. In patients with DM onset in young age, it is challenging to correctly identify the DM type, therefore, it is essential to know the peculiarities of the onset and progression of each type. DM1 patients present with severe pancreatic β-cell dysfunction. Slow immunemediated DM is diagnosed in the presence of glutamic acid decarboxylase antibodies, but without any need to use insulin for 1 year after the diagnosis. DM2 is characterised with normal or elevated C-peptide levels, absence of antibodies, and presence of some signs of metabolic syndrome. In young patients, DM with autosomal dominant inheritance can be verified, which is caused by pathogenic mutations in associated genes — MODY (Maturity Onset Diabetes of the Young).
Conclusion. A review of literature demonstrates the need in thorough differential diagnosis of a DM type if young patients present with hyperglycaemia.
About the Authors
A. K. OvsyannikovaRussian Federation
175/1 Boris Bogatkov Str., Novosibirsk, 630089
R. B. Galenok
Russian Federation
175/1 Boris Bogatkov Str., Novosibirsk, 630089; 52 Krasny Ave, Novosibirsk, Russian Federation 630091
O. D. Rymar
Russian Federation
175/1 Boris Bogatkov Str., Novosibirsk, 630089
References
1. Dedov I.I., Shestakova M.V., Mayorov A.Y. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 10th edition. Diabetes mellitus. 2021;24(S1):1–148. (in Russian). DOI: 10.14341/DM12802
2. Kudentsova L.A., Davydov D.V., Chernavsky S.V., Stremoukhov A.A. Classification of diabetes: a new view on the problem. Lechaschi Vrach. 2022;(5-6):84–90. (in Russian). DOI: 10.51793/OS.2022.25.6.015
3. Eizirik D.L., Pasquali L., Cnop M. Pancreatic β-cells in type 1 and type 2 diabetes mellitus: different pathways to failure. Nat. Rev. Endocrinol. 2020;16:349–362. DOI: 10.1038/s41574-020-0355-7
4. Оvsyannikova А. K., Zubareva D. Y. Features of the course of type 2 diabetes in young persons. Medical council. 2022;16(10):57–61. (in Russian). DOI 10.21518/2079-701X-2022-16-10-57-61
5. Dedov I.I., Shestakova M.V., Mayorov A.Yu. et al. Type 2 diabetes mellitus in adults. Diabetes mellitus. 2020;23(2S):4–102. (in Russian). DOI: 10.14341/ DM12507
6. Kononenko I.V., Shestakova M.V., Elfimova A.R. et al. Ethnic differences in risk factors and prevalence of type 2 diabetes in the adult population of the Russian Federation. Diabetes mellitus. 2022;25(5):418–438. (in Russian). DOI: 10.14341/DM12935
7. Zhabbarov O.O., Umarova Z.F., Tursunova L.D. et al. Association of polymorphic markers Leu28pro of the Apoe gene and Pro12ala of the Pparg2 gene in diabetic nephropathy in type 2 diabetic patients. Central Asian Journal of Medical and Natural Science. 2023;4(1):146–152. (in Russian). DOI: 10.17605/OSF.IO/G2ZSJ
8. Nikonova T.V. Type 1 diabetes mellitus and latent autoimmune diabetes in adults (LADA): clinical, immunogenetic and hormonal-metabolic aspects. International Journal of Endocrinology. 2011;(7):24–32. (in Russian).
9. Aycan Z., Berberoglu M., Adiyaman P. et al. Latent autoimmune diabetes mellitus in children (LADC) with autoimmune thyroiditis and Celiac disease. J. Pediatr. Endocrinol. Metab. 2018;17(11):1565–1569. DOI: 10.1515/jpem.2004.17.11.1565
10. Pozdnyak A.O. Latent autoimmune diabetes in adults (LADA): issues and prospects for treatment. Medical almanach. 2019;(3):8–9. (in Russian). DOI: 10.33029/2304-9529-2021-10-2-112-117
11. Shestakova M.V., Sukhareva O.Yu. Type 2 diabetes mellitus: is it easy to diagnose and how to choose a treatment. Doctor.Ru. 2017;(13–14):44–51. (in Russian).
12. Tosur M., Philipson L.H. Precision diabetes: lessons learned from maturity-onset diabetes of the young (MODY). J. Diabetes Invest. 2022;13(9):1465-1471. DOI: 10.1111/jdi.13860
13. Jung M.K., Kwak J.E., Shin E.C. IL-17A-producing Foxp3+ regulatory T cells and human diseases. Immune Netw. 2019;17(5):276–286. DOI: 10.4110/in.2017.17.5.276.
14. Aitbaev K.A., Murkamilov I.T., Murkamilova Z.A. et al. Diagnosis and treatment of monogenic forms of diabetes mellitus: MODY-diabetes in focus. Archive of Internal Medicine. 2022;12(6):430–437. (in Russian). DOI: 10.20514/2226-6704-2022-12-6-430-437
15. Ovsyannikova A.K., Shakhtshneider E.V., Ivanoschuk T.E., Rymar O.D. Determination of significant features for diagnosing type 2 diabetes mellitus and MODY using binary logistic regression. Innovative technologies in endocrinology. In: Proceedings of the All-Russian Scientific and Practical Conference with the participation of the RIAC. Moscow, September 21–22, 2021 Moscow; 2021: 74. (in Russian). DOI: 10.14341/Conf22-25.09.21-74
16. Zhao Y., Scott N.A., Quah H.S. et al. Mouse pancreatic beta cells express MHC class II and stimulate CD4(+) T cells to proliferate. Eur. J. Immunol. 2019;45(9):2494–2503. DOI: 10.1002/eji.201445378
17. Demidova T.Yu., Gritskevich E.Yu., Izmailova M.Ya. Features of differential diagnosis of diabetes mellitus in the modern world: clinical observation. Endocrinology: News. Opinions. Education. 2021;(2):112–117. (in Russian). DOI: 10.33029/2304-9529-2021-10-2-112-117
18. Piccioni A., Rosa F., Mannucci S. et al. Gut microbiota, LADA, and type 1 diabetes mellitus: an evolving relationship. Biomedicines. 2023;11(3):707. DOI: 10.3390/biomedicines11030707
19. Panova D.Yu., Arbanakova A.A. Features of diagnostic and differential diagnostic approaches for LADA and MODY. Forcipe. 2020;3(S1):359–360. (in Russian).
20. Singh K., Martinell M., Luo Z. et al. Cellular immunological changes in patients with LADA are a mixture of those seen in patients with type 1 and type 2 diabetes. Clin. Exp. Immunol. 2019;197(1):64–73. DOI: 10.1111/cei.13289
21. Niu X., Luo S., Li X. et al. Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8. Diabetes Metab. Res. Rev. 2019;35(1):e3068. DOI: 10.1002/dmrr.3068
22. Alam U., Jeziorska M., Petropoulos I.N. et al. Latent autoimmune diabetes of adulthood (LADA) is associated with small fibre neuropathy. Diabet. Med. 2019;36(9):1118–1124. DOI: 10.1111/dme.13888
23. Al-Zubairi T., Al-Habori M., Saif-Ali R. Latent autoimmune diabetes in adults (LADA) and its metabolic characteristics among yemeni type 2 diabetes mellitus patients. Diabetes Metab. Syndr. Obes. 2021;14:4223– 4232. DOI: 10.2147/DMSO.S332416
24. Carlsson S. Etiology and pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) compared to type 2 diabetes. Front. Physiol. 2019;10:320. DOI: 10.3389/fphys.2019.00320
25. Pozzilli P., Pieralice S. Latent Autoimmune Diabetes in Adults: current status and new horizons. Endocrinol. Metab. (Seoul). 2018;33(2):147– 159. DOI: 10.3803/EnM.2018.33.2.147
26. Jones A.G., McDonald T.J., Shields B.M. et al. Latent autoimmune diabetes of adults (LADA) is likely to represent a mixed population of autoimmune (type 1) and nonautoimmune (type 2) diabetes. Diabetes Care. 2021;44(6):1243–1251. DOI: 10.2337/dc20-2834
27. Jörns A., Wedekind D., Jähne J., Lenzen S. Pancreas pathology of latent autoimmune diabetes in adults (LADA) in patients and in a LADA rat model compared with type 1 diabetes. Diabetes. 2020;69(4): 624–633. DOI: 10.2337/db19-0865
28. Wu H.X., Chu T.Y., Iqbal J. et al. Cardio-cerebrovascular outcomes in MODY, type 1 diabetes, and type 2 diabetes: a prospective cohort study. J. Clin. Endocrinol. Metab. 2023;dgad233. DOI: 10.1210/clinem/dgad233
29. Urakami T. Maturity-onset diabetes of the young (MODY): current perspectives on diagnosis and treatment. Diabetes Metab. Syndr. Obes. 2019;12:1047–1056. DOI: 10.2147/DMSO.S179793
30. Tönnies T., Brinks R., Isom S. et al. Projections of type 1 and type 2 diabetes burden in the US population aged< 20 years through 2060: the SEARCH for Diabetes in Youth study. Diabetes Care. 2023;46(2): 313–320.
31. Vich-Pérez P., Abánades-Herranz J.C., Mora-Navarro G. et al. Development and validation of a clinical score for identifying patients with high risk of latent autoimmune adult diabetes (LADA): The LADA primary careprotocol study. PLoS One. 2023;18(2):e0281657. DOI: 10.1371/journal.pone.0281657
Review
For citations:
Ovsyannikova A.K., Galenok R.B., Rymar O.D. Key Principles of Differential Diagnosis of Diabetes Mellitus Types in Young Patients. Title. 2023;22(4):24-28. (In Russ.) https://doi.org/10.31550/1727-2378-2023-22-4-24-28