T1d Classification
Attempts to distinguish T1D cases from those with T2D have also resulted in a proposed new disease classification, Latent
Autoimmune Disease of Adults (LADA) (Leslie et al., 2008).
However, over this past decade, the lack of firm diagnostic criteria for LADA, taken together with other notions (e.g., genetic similarity between those with T1D and the so-called
LADA patients), have dramatically decreased, but not eliminated, enthusiasm for adopting this presumed “new” disease entity as a novel category for diabetes (Rolandsson,
2010). To be clear, such confusion over disease classification in settings of diabetes is not new because many terms (e.g., insulin-requiring diabetes, juvenile diabetes, insulin-dependent diabetes mellitus, etc.) have …show more content…
For T1D, expert panels formed under the auspices of the American Diabetes Association (ADA), as well as the
World Health Organization (WHO), were instrumental in defining criteria for the diagnosis of and selecting the terminology for what considered T1D and T2D (American
Diabetes Association, 2010).
Beyond a lack in understanding the boundaries for age on
T1D, another facet subject to considerable debate relates to
T1D heterogeneity, both in terms of patient disease course as well as pathogenic mechanisms that underlie the disorder’s
!5
Review of Literature Type 1 Diabetes formation. As noted above, T1D is considered, with near uniformity, to represent a disorder “autoimmune” in nature— meaning that patients often express features reflective of an immunological contribution to their disease pathogenesis (e.g., autoantibodies, genes associated with immune-related genetic susceptibly, etc.).Yet, not all T1D patients possess these characteristics; leading some to the proposed classification of type 1A (autoimmune) diabetes (Eisenbarth, 2007) for the …show more content…
EPIDEMIOLOGY: INCIDENCE AND PREVALENCE
!6
Review of Literature Type 1 Diabetes
Type 1 diabetes is without question one of the most common chronic diseases of childhood (Karvonen et al.,
2000). Here too, a variety of epidemiological notions (i.e., dogmas) appear, at least on their surface, firm in their proposition, whereas other concepts are less sure (Gale, 2005).
First, it does appear that two peaks of T1D presentation occur in childhood and adolescence—one between 5 and 7 year of age, with the other occurring at or near puberty (Harjutsalo et al., 2008). Beyond this, although many autoimmune disorders disproportionately affect women, T1D appears to affect males and females equally; but controversy does exist whether amodest excess of T1D cases occurs in males in early age or signs of autoimmunity are increased with male gender (Weets et al., 2001; Krischer et al., 2004). In addition, the incidence of T1D varies as a function of seasonal changes, higher in autumn and winter and lower in the summer months
(Moltchanova et al., 2009). The pathogenic mechanisms that underlie these seemingly sure observations are unclear, but, interestingly, some studies assessing the development of
Autoimmune Disease of Adults (LADA) (Leslie et al., 2008).
However, over this past decade, the lack of firm diagnostic criteria for LADA, taken together with other notions (e.g., genetic similarity between those with T1D and the so-called
LADA patients), have dramatically decreased, but not eliminated, enthusiasm for adopting this presumed “new” disease entity as a novel category for diabetes (Rolandsson,
2010). To be clear, such confusion over disease classification in settings of diabetes is not new because many terms (e.g., insulin-requiring diabetes, juvenile diabetes, insulin-dependent diabetes mellitus, etc.) have …show more content…
For T1D, expert panels formed under the auspices of the American Diabetes Association (ADA), as well as the
World Health Organization (WHO), were instrumental in defining criteria for the diagnosis of and selecting the terminology for what considered T1D and T2D (American
Diabetes Association, 2010).
Beyond a lack in understanding the boundaries for age on
T1D, another facet subject to considerable debate relates to
T1D heterogeneity, both in terms of patient disease course as well as pathogenic mechanisms that underlie the disorder’s
!5
Review of Literature Type 1 Diabetes formation. As noted above, T1D is considered, with near uniformity, to represent a disorder “autoimmune” in nature— meaning that patients often express features reflective of an immunological contribution to their disease pathogenesis (e.g., autoantibodies, genes associated with immune-related genetic susceptibly, etc.).Yet, not all T1D patients possess these characteristics; leading some to the proposed classification of type 1A (autoimmune) diabetes (Eisenbarth, 2007) for the …show more content…
EPIDEMIOLOGY: INCIDENCE AND PREVALENCE
!6
Review of Literature Type 1 Diabetes
Type 1 diabetes is without question one of the most common chronic diseases of childhood (Karvonen et al.,
2000). Here too, a variety of epidemiological notions (i.e., dogmas) appear, at least on their surface, firm in their proposition, whereas other concepts are less sure (Gale, 2005).
First, it does appear that two peaks of T1D presentation occur in childhood and adolescence—one between 5 and 7 year of age, with the other occurring at or near puberty (Harjutsalo et al., 2008). Beyond this, although many autoimmune disorders disproportionately affect women, T1D appears to affect males and females equally; but controversy does exist whether amodest excess of T1D cases occurs in males in early age or signs of autoimmunity are increased with male gender (Weets et al., 2001; Krischer et al., 2004). In addition, the incidence of T1D varies as a function of seasonal changes, higher in autumn and winter and lower in the summer months
(Moltchanova et al., 2009). The pathogenic mechanisms that underlie these seemingly sure observations are unclear, but, interestingly, some studies assessing the development of