INDIANAPOLIS — A new review looked at adult-onset Type 1 diabetes and methods to improve screening and diagnosis.
T1D has been historically regarded as a childhood-onset disease, according to the study team led by the Indiana University School of Medicine and including participation from the Roudebush VAMC in Indianapolis.
The researchers explained that “recent epidemiological data indicate that adult-onset T1D accounts for a substantial proportion of cases worldwide. There is evidence that adult-onset T1D is associated with the classic T1D triad of elevated genetic risk, the presence of islet-specific autoantibodies and progression to severe insulin deficiency.”
The article published in Diabetes, Obesity & Metabolism reviews the understanding of the commonalities and differences between childhood and adult-onset T1D, highlighting significant knowledge gaps in the understanding of the diagnosis, incidence, trajectory and treatment of adult-onset T1D.1
“Compared to children, adults presenting with T1D exhibit differences in genetic risk, immunologic profiles and metabolic outcomes, including differences in the type and number of autoantibodies present, genetic associations and total genetic burden, rates of C-peptide decline, the persistence of C-peptide in long-duration disease and glycaemic control,” the authors pointed out. “In addition, obesity and metabolic syndrome are increasingly common in adults, which not only blurs the clinical distinction of adult-onset T1D from type 2 diabetes (T2D) but also likely contributes to differences in metabolic outcomes and rates of progression.”
The researchers noted that, because T2D is so prevalent in the adult population, adult-onset T1D is misclassified as T2D in at least 1 in 3 cases. That can lead to delays in appropriate treatment.
Part of the issue, according to the report, is that current diagnostic tools, including autoantibody testing and C-peptide measurement, are underutilized or lack specificity in distinguishing adult-onset T1D from atypical T2D. Complicating the matter is that the impact of different responses to disease-modifying therapy between adults and children is unclear, the study team added.
“Addressing these knowledge gaps requires expanded epidemiological studies, diverse patient registries and refined classification criteria to improve early detection and treatment strategies,” according to the authors. “A deeper understanding of adult-onset T1D will be critical to reduce the burden of misdiagnosis, lead to earlier diagnosis and treatment and optimize population-based screening approaches in this under-recognized population”.
- Evans-Molina C, Oram RA. Type 1 diabetes presenting in adults: Trends, diagnostic challenges and unique features. Diabetes Obes Metab. 2025 Apr 15. doi: 10.1111/dom.16402. Epub ahead of print. PMID: 40230204.