Do You Know About These 3 Lesser-Known Types Of Diabetes?

by Dr. Jonathan D'Souza

The Centers for Disease Control and Prevention states that about 25.8 million people in the US are living with diabetes. Most often, these individuals would be classified as type1, type 2 or gestational diabetes (diabetes during pregnancy). In adults, type 1 diabetes can account for nearly 5 percent of all diagnoses, type 2 for 90 to 95 percent of all cases and gestational diabetes for nearly two to 10 percent of pregnancies.

Although uncommon, there are still other types of diabetes that people aren’t aware of. On #WorldDiabetesDay, we take a look at three lesser-known types of diabetes.

1) Latent Autoimmune Diabetes Of Adults (LADA)
Latent autoimmune diabetes of adults (LADA) is a slow, progressive form of type 1 diabetes that is often mistaken for type 2 diabetes. People with LADA may have weight loss and even need insulin therapy for many years, even though they experience autoimmune beta-cell destruction associated with type 1 diabetes. Because of this, some health care organization refer to LADA as double diabetes or type 1.5 diabetes.

Though LADA shares characteristics that are similar to type 1 and type 2 diabetes, there are clinical distinctions that can be made.

People with LADA don’t have high blood pressure or high cholesterol, have a healthy weight and are active with no family history of type 2 diabetes. However, people with LADA may have a family history of autoimmune diseases such as rheumatoid arthritis or thyroid disease.

Researchers have found that approximately 10 to 30 percent of people diagnosed with type 2 diabetes could possibly have LADA.  For a short duration (six to eight months and may go on for 2 years), individuals can control with dietary modification but will eventually need oral medication and insulin therapy. Common symptoms include unstable blood glucose levels, ketosis (raised levels of ketone bodies in the body), weight loss and low C-peptide levels—a byproduct formed when insulin is produced.

2) Maturity-Onset Diabetes Of The Young (MODY)
An uncommon form of diabetes that accounts for 1-5 percent of all cases in young people, maturity onset diabetes of the young (MODY) is a form of monogenic diabetes caused by a genetic defect of the beta cell in the pancreas.

While various genes are responsible for  type 1 or type 2 diabetes, monogenic diabetes results from a mutation in a single gene. This type of diabetes does not cause insulin resistance like in type 2 diabetes or autoimmunity as in type 1 diabetes but instead causes diabetes by blunting the beta cell’s capacity to release insulin.

  • Unlike people with type 1 diabetes, who always require insulin, people with MODY can often be treated with oral diabetes medications.
  • It first occurs during adolescence or early adulthood. However, it can remain undiagnosed until later in life.
  • Patients initially diagnosed as having type 1 diabetes but aren’t positive for autoantibodies or who have near normal blood glucose levels on minimal insulin should be screened for it.
  • It is important to have the right diagnosis since it can be managed with oral hypoglycemic agents. An accurate diagnosis can mean the difference between a lifetime of insulin injections or effective control over blood sugar levels with a sulfonylurea.

3) Cystic Fibrosis-Related Diabetes (CFRD)
CFRD is an inherited disease of the mucus and sweat glands. The primary complication in cystic fibrosis is a chronic pulmonary disease. Up to 75 percent of adults with cystic fibrosis develop glucose intolerance, and nearly 15 percent have CFRD.

Patients with CFRD show signs of type 1 and type 2 diabetes. Chronic inflammation of the pancreas can reduce beta cell mass that is associated with type 1 diabetes. As a result of chronic pulmonary infections, CFRD patients develop severe insulin resistance that is associated with type 2 diabetes.

The American Diabetes Association’s 2009 Clinical Care Guidelines for Cystic Fibrosis–Related Diabetes says that during a period of stable health, a diagnosis can be made in cystic fibrosis patients according to the usual glucose criteria. In periods of acute illness, a CFRD diagnosis can be made when fasting plasma glucose levels are at or above 126 mg/dL, or two-hour postprandial plasma glucose levels at or above 200 mg/dL persist for more than 48 hours.

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References:
1. National Diabetes Statistics, 2011. Centers for Disease Control and Prevention website.http://www.cdc.gov/diabetes/pubs/factsheet11.htm.
2. American Diabetes Association. Standards of medical practice – 2014. Diabetes Care. 2014;37(1):S14-S80.
3. American Association of Diabetes Educators. The Art & Science of DSME Desk Reference. Chicago, Illinois: AADE 2011. Ed: Carole Mensing.
4. Diabetes Overview. National Diabetes Information Clearing House website.http://diabetes.niddk.nih.gov/dm/pubs/overview/ – other.
5. Unger J. Latent autoimmune diabetes in adults. Am Fam Physician. 2010;81(7):843-847.
6. ADA/JDRF Type 1 Diabetes Sourcebook, Excerpt #1: Diagnosing Diabetes. Diabetes In Control website. http://www.diabetesincontrol.com/articles/85-/14583-adajdrf-type-1-diabetes-sourcebook-excerpt-1-diagnosing-diabetes. Updated May 5, 2013.
7. Moran A, Brunzell C, Cohen R, et al. Clinical care guidelines for cystic fibrosis–related diabetes. Diabetes Care. 2010;33(12):2697-2708.

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