Errors in Diagnosing Types of Diabetes in Young Adult Patients – Constantly Valid Topic

Abstract

Rapid accumulation of clinical Abstract The correct differentiation of diabetes types is still a problem. This is especially true for groups of young adult patients between 20 and 55 years old. In this group of patients Type 2 diabetes is still routinely diagnosed, without a thorough analysis of the patient’s history, phenotype, as well as disregarding the need to perform all necessary laboratory tests. Such diagnostic irregularities lead to taking wrong therapeutic decisions. As far as the patient’s history is concerned, attention should be paid to the incidence or non-incidence of a positive history of diabetes in the patient’s family. In the autoimmune diabetes such incidence usually does not occur. In Type 2 diabetes it is usually high, whereas most often it occurs on the patient’s mother’s and well as father’s side. A feature that is usually very characteristic is high incidence on one side of the family, typical for monogenic diabetes. A very important indicator is the occurrence or non-occurrence of obesity. Clear obesity suggests the diagnosis of Type 2 diabetes, whereas in patients without obesity LADA or MODY diabetes needs to be taken into account. Conclusive in this respect are the results of tests checking the levels of C-peptide and the titre of autoantibodies, predominantly of a/GAD. When MODY diabetes is suspected, it is necessary to run genetic tests. It is extremely important to undertake efforts aiming at a correct diagnosis of the etiological cause of diabetes, i.e. determining whether we deal with the autoimmunization process, insulin resistance, or with a genetic defect, as it influences therapeutic decisions. In the presence of the autoimmunization process, it is recommended to provide the insulin therapy at an early stage. In patients with clearly marked insulin resistance an early onset of the insulin therapy should be avoided. The first choice drugs in this condition are metformin, incretin drugs, as well as drugs from the group of SGLT-2 inhibitors. In monogenic diabetes therapeutic decisions depend on the type of the genetic defect.