Adult onset type 1 diabetes
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Adult-Onset Type 1 Diabetes: Incidence, Characteristics, and Challenges
Incidence of Adult-Onset Type 1 Diabetes
Global Incidence Patterns
Adult-onset type 1 diabetes (T1D) is increasingly recognized as a significant health issue, with more than half of new T1D cases occurring in adults. The incidence varies globally, being lowest in Asian countries and highest in Nordic countries . Notably, adult-onset T1D is more prevalent in men than in women . However, there is a paucity of data from low- and middle-income countries, making it challenging to fully understand the global burden.
Age and Incidence Trends
The incidence of T1D tends to decrease with age after peaking in puberty and early adulthood . Despite this, the prevalence remains high among adults due to the chronic nature of the disease. It is also unclear whether the incidence of adult-onset T1D has changed over time.
Characteristics of Adult-Onset Type 1 Diabetes
Genetic and Immunological Differences
Adult-onset T1D exhibits distinct genetic and immunological profiles compared to childhood-onset T1D. Adults with T1D have lower HLA-associated risk, more protective genotypes, and lower genetic risk scores . They also show decreased levels of multiple diabetes-associated autoantibodies, although GADA remains dominant . Additionally, adults tend to have higher serum C-peptide levels at diagnosis and less frequent ketoacidosis compared to children .
Clinical Presentation and Progression
The clinical presentation of adult-onset T1D can often be mistaken for type 2 diabetes (T2D), leading to misclassification and inappropriate treatment. Despite similar presentation characteristics, older adults are less likely to be diagnosed with T1D, receive insulin treatment, or be admitted to the hospital. The progression of the disease, including C-peptide loss and genetic susceptibility, does not significantly differ with the age of diagnosis.
Psychosocial and Management Challenges
Psychosocial Aspects
Adults with T1D face unique psychosocial challenges that can affect disease management. These include the need for continuous decision-making, the importance of knowledge and personal preferences, and the critical role of support systems. Psychosocial health status and interventions targeting these aspects are crucial for effective management.
Decision-Making Needs
The decision-making needs of adults with T1D are complex and individualized. They require access to reliable information, support, and opportunities for participation in decision-making processes. Tailored approaches are necessary to address the sudden and pervasive nature of diabetes-related decisions.
Conclusion
Adult-onset type 1 diabetes is a significant and complex health issue with distinct epidemiological, genetic, and clinical characteristics. The incidence varies globally, with higher rates in men and certain regions. Adults with T1D face unique challenges, including misclassification risks and psychosocial burdens. Understanding these differences and addressing the specific needs of adults with T1D is crucial for improving diagnosis, treatment, and overall management.
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