Type 1 diabetes presenting initially as type 2 diabetes which remitted with lifestyle change: a case report
DOI:
https://doi.org/10.15277/bjd.2025.489Keywords:
Type 1, diabetes, diagnosis, antibodiesAbstract
We present a case of type 1 diabetes (T1DM) in a middle-aged Caucasian woman who initially presented with phenotypic characteristics of type 2 diabetes (T2DM) and whose type 2 phenotype contributed to accelerated progression of T1DM. This case illustrates the challenges in making a clinical diagnosis of T1DM in patients who also have phenotypic features of T2DM. Recognising such presentations is important in order to make the correct diagnosis and potentially to offer immunotherapy-based interventions while beta cell function is still relatively well preserved.
References
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32(Suppl 1):S62-67. https://pmc.ncbi.nlm.nih.gov/articles/PMC2613584/ https://doi.org/10.2337/dc09_S062
Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: an overview. Avicenna J Med 2020;10(4):174-88. https://pmc.ncbi.nlm.nih.gov/articles/PMC7791288/ https://doi.org/10.4103/ajm.ajm_53_20
Hurtado MD, Vella A. What is type 2 diabetes? Medicine 2019;47(1):10–5. https://doi.org/10.1016/j.mpmed.2018.10.010
Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care 2015;38(10):1964–74. https://dx.doi.org/10.2337/dc15-1419
Lundgren VM, Isomaa B, Lyssenko V, et al. GAD antibody positivity predicts type 2 diabetes in an adult population. Diabetes 2010; 59(2):416–22. https://doi.org/10.2337/dbog-0747
T1T2 classification // diabetes genes. [cited 17/2/2025] https://www.diabetesgenes.org/t1t2-classification/
Redondo MJ, Evans-Molina C, Steck AK, Atkinson MA, Sosenko J. The influence of type 2 diabetes-associated factors on type 1 diabetes. Diabetes Care 2019;42(8):1357–64. https://pubmed.ncbi.nlm.nih.gov/31167894/ https://doi.org/10.2337/dc19-0102
Buzzetti R, Zampetti S, Pozzilli P. Impact of obesity on the increasing incidence of type 1 diabetes. Diabetes Obes Metab 2020;22(7):1009–13. https://pubmed.ncbi.nlm.nih.gov/32157790/ https://doi.org/10.1111/dom.14022
Fourlanos S, Narendran P, Byrnes GB, Colman PG, Harrison LC. Insulin resistance is a risk factor for progression to type 1 diabetes. Diabetologia 2004;47(10):1661–7. https://pubmed.ncbi.nlm.nih.gov/15480539/ https://doi.org/10.1007/s00125-004-1507-3
Tatovic D, Narendran P, Dayan CM. A perspective on treating type 1 diabetes mellitus before insulin is needed. Nat Rev Endocrinol 2023;19(6):361–70. https://pubmed.ncbi.nlm.nih.gov/36914759/ https://doi.org/10.1038/s41574-023-00116-5
Corbin KD, Driscoll KA, Pratley RE, Smith SR, Maahs DM, Mayer- Davis EJ. Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms. Endocr Rev 2018;39(5):629–63. https://dx.doi.org/10.1210/er.2017-00191
Besser REJ, Bell KJ, Couper JJ, et al. ISPAD clinical practice consensus guidelines 2022: stages of type 1 diabetes in children and adolescents. Pediatric Diabetes 2022;23:1175–87. https://doi.org/10.1111/pedi.13410
El Sayed NA, McCoy RG, Aleppo G, et al. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025. Diabetes Care 2025;48(Supplement_1):S27–49. https://pubmed.ncbi.nlm.nih.gov/39651986/ https://doi.org/10.2337/dc25-S002
Bauer W, Gyenesei A, Krętowski A. The multifactorial progression from the islet autoimmunity to type 1 diabetes in children. Int J Mol Sci 2021;22(14):7493. https://pubmed.ncbi.nlm.nih.gov/34299114/ https://doi.org/10.3390/ijms22147493
Editorial. Alarming rise in young-onset type 2 diabetes. Lancet Diabetes Endocrinol 2024;12(7):433. http://www.thelancet.com/article/S221385872400161X/fulltext https://doi.org/10.1016/S2213-8587(24)00161-X
Pinhas-Hamiel O, Zeitler P. Type 2 diabetes in children and adolescents- a focus on diagnosis and treatment. Endotext 2023: [cited 16/2/2025] https://www.ncbi.nlm.nih.gov/books/NBK597439/
Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol 2018;6(1):69–80. https://doi.org/10.1016/s2213-8587(17)30186-9
Sadat A. Alarming surge in early-onset type 2 diabetes: a global catastrophe on the horizon. touchREV Endocrinol 2023;19(2):7. https://pmc.ncbi.nlm.nih.gov/articles/PMC10688561/ https://doi.org/10.17925/EE.2023.19.2.5
NICE guideline NG17. Type 1 diabetes in adults: diagnosis and management, updated 2022. nice.org.uk
Herold KC, Bundy BN, Long SA, et al. An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes. N Engl J Med 2019;381(7):603–13. https://pubmed.ncbi.nlm.nih.gov/31180194/ Published correction 2020;382(6):586. http://www.ncbi.nlm.nih.gov/pubmed/32023396
First ever treatment to delay type 1 diabetes is licensed in the US [Internet]. [cited 2025 Feb 18]. https://www.diabetes.org.uk/about- us/news-and-views/first-treatment-delay-type-1-diabetes-teplizum ab-licensed-us
Current research – UKT1D Research Consortium [Internet]. [cited 2025 Feb 19]. https://type1diabetesresearch.org.uk/current- research/
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