Distinguishing type 1 from type 2 diabetes mellitus (DM) depends on clinical presentation, titers of antibodies and requirement for insulin therapy. Need for insulin per se is not a major difference between those two types. We measured the presence of antibodies for glutamic acid decarboxylase (GAD), islet–cell antibodies (ICA), insulinoma–associated protein 2 (IA–2) and the level of C–peptide in a group of 10 patients whose diagnosis of type 2 DM was established several years ago. The reasons for revision were glucose variability, elevated HbA1c in some patients, basal–bolus sheme from the beginning of diagnosis in several patients, presence of unknown hypoglycemias and need for flash glucose monitoring (FGM, “Libre”) which is indicated with reimbursement of health care system in type 1 patients in our country. After revision, one male and one female patient were still type 2 DM (ICA, GAD, IA–2 negative, C–peptide 0.35 and 0.41 nmol/l), the duration of disease was 5 and 7 years, respectively. After peroral therapy for 4 and 6 yrs, basal oral regime was used. Among other 8 patients 6 patients were revised to be LADA (two males, 4 females) with positive ICA and GAD, low C–peptide. One male and one female were type 1 (DM 11 and 17 yrs, basal bolus therapy). In 2 pts with LADA, basal–bolus was started from the beginning of diagnosis (duration of DM 6–15 yrs), in 4 pts with LADA duration of DM was 5–30 yrs (peroral therapy first several years). All LADA/ type 1 patients got FGM. Conclusion: availability of FGM and new drugs for DM require that we consider revising the type of DM in some patients in order to provide them with the best care possible.
Keywords: type 1, type 2, revision, flash glucose monitoring.
05 Sep 2020 - 09 Sep 2020