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Autoimmune diabetes in adults: current evidence and controversies
Published on October 31, 2021 33 min
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Hello, my name is David Leslie. I'm going to talk to you about autoimmune diabetes in adults, current evidence and controversies. I work at the Blizard Institute in Barts at the University of London.
These are my disclosures and funding.
This work I'm describing has been done by many people around the world, both in my department as well as in Europe, in China, in America, and the people who have been particularly helpful in this collaborative process are shown here, though there are many others who are not included.
The plan of his presentation is four-fold: the nature of autoimmune disease; describing the immunogenetic features of disease; the non-genetic effects associated with disease; and the clinical utility of identifying autoimmune disease. Here I'm using autoimmune disease as a general feature, but I'm specifically interested in the autoimmune disease known as type 1 diabetes.
Type 1 diabetes is a form of diabetes with a high blood sugar associated with a striking spectrum of diabetes, which ranges from juvenile onset to old age. The more you get older, the less likely you are to require insulin treatment. It was nearly 100 years ago that diabetes was diagnosed in a child who received insulin, and survived. In those days, this was seen as a lethal childhood-onset disease, and became known as 'insulin-dependent diabetes', and subsequently type 1 diabetes. The other type, the type that did not require insulin, was known as 'maturity-onset diabetes', and more recently type 2 diabetes. However, the distinction between these two is entirely confined to the features associated with type 1 (insulin-dependent) diabetes. Over the years it's become apparent the distinction is not quite as categorical as it would appear. We now think of autoimmune diabetes extending across the age range, and I'll show you, indeed, that the most common form of this type 1 diabetes is in adult life, presenting as an adult, and often not requiring insulin - at least initially.