Diabetes is no longer as simple as dividing it into Type 1 and Type 2. Advances in diagnostic tools and a better understanding of the condition have revealed a complex spectrum of diabetes types that challenge traditional classifications. What was once diagnosed primarily by age of onset, body type, and insulin requirements now requires a closer look at factors like insulin resistance, beta cell function, and the presence of antibodies. These shifts have significant implications for treatment and management, highlighting the need for tailored approaches that address the unique needs of each individual with diabetes.
Other changes have occurred. Many people diagnosed as having one type also have the other! Many people are diagnosed with Type 2 in their teens, and one in six adults diagnosed with Type 2 diabetes carries the insulin antibodies characteristic of Type 1 diabetes. Over time, many of those with Type 2 diabetes lose beta cell function and become insulin-dependent like Type 1. However, new gut hormone medications are slowing and even reversing this decline. Those with Type 2 diabetes can have beta cell antibodies or lose their insulin production after prolonged hyperglycemia. AID systems and pumps benefit people regardless of the type of diabetes they have.
Insulin antibodies in people diagnosed with Type 2 diabetes hasten the decline in insulin production and create an earlier need for outside insulin. The large UKPDS study found that 94% diagnosed with Type 2 having antibodies required insulin within six years of diagnosis, compared to only 16% with no antibodies.1 Fortunately, today’s new GLP-1s and similar dual and triple agonists significantly prolong beta cell function. They also appear to delay the loss of insulin production in those recently diagnosed with Type 1 diabetes. More teens are being diagnosed with Type 2 diabetes, and some have antibodies, so checking is essential for appropriate therapy with insulin incretins.
| 1.12 Difference in the Three Major Types of Diabetes | ||||
|---|---|---|---|---|
| Type 1 | Type 2 with antibody or loss of insulin production | Type 2 | ||
| Avg age at the start | 12 | 46 | 61, now falling with the increase in teen onset | |
| Typical age at the start | 3-40* | 15-70* | 35-80* | |
| % of all diabetes | 5% (20%**) | 15% | 80% | |
| Insulin problem | absence | deficiency | resistance | |
| Time to insulin start | days | months or years | years, decades, or never | |
| Antibodies | IA-2A, GAD65, IAA, ZnT8Ab, ICA*** | mostly GAD65, some IA-2 | none | |
| Other helpful tests | low C-peptide | low or normal C-peptide | normal or high C-peptide, low HDL, high TGs | |
| * May occur at any age ** With the inclusion of all antibody-positive cases, i.e., Type 1 and Type 2 with +antibodies *** For free antibody testing, visit TrialNet.org/participate or AskHealth.org |
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