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| Name | Diagnosing Diabetes Many Variations in Type 2 Profile |
| Video Uploader | Video From Medscape |
| Upload Date | This Video Uploaded At 14-11-2023 09:30:01 |
| Video Discription | As part of a four-part series on diagnosing diabetes, Anne Peters, MD, discusses the many variations in type 2 and treating patients with type 2 diabetes. https://www.medscape.com/viewarticle/996918?src=soc_yt -- TRANSCRIPT -- Most adults with diabetes have type 2 diabetes, which is a polygenic disorder, meaning that we haven't found just one gene that defines it. We all know what we consider to be classic type 2 diabetes: someone who is perhaps older, heavier, has metabolic syndrome, and has family members with diabetes. However, looks can be deceiving. In my type 1 clinic in East Los Angeles, I see many Latino individuals with type 1 diabetes who also have metabolic syndrome and are often misdiagnosed as having type 2 diabetes. When I see these patients, I tend to diagnose them based on a positive islet autoantibody level and/or their clinical requirement for insulin. I also do a large amount of continuous glucose monitoring (CGM) in people with type 2 diabetes, even those on noninsulin therapies, and I see so many different variations in daily glucose profiles. It's often hard to believe that all of these people have the same disorder. I'm sure we're going to find many subtypes of type 2 diabetes even though we haven't defined them yet. A number of people have tried to categorize type 2 diabetes into these subtypes. In 2018, a group from Sweden published a suggested classification into five subtypes of adults with diabetes, and these subtypes have actually seemed to hold true when others have looked into these classifications in their populations. First, right off the bat, about 6% have what they call severe autoimmune diabetes or latent autoimmune diabetes in adults (LADA), but the remaining 94% have what we would call classic type 2. The first and most common type is called moderate age-related diabetes. The next type is moderate obesity-related diabetes. The two least common types are severe insulin-resistant diabetes and severe insulin-deficient diabetes. I bet if you think about it, you can remember patients who might fit in each of these different subtypes. I think of this when I see patients in my clinic, but one of the most important components is that the rates of different complications differ based on the subtype of diabetes. For instance, severe insulin-deficient type 2 diabetes has higher rates of retinopathy while severe insulin-resistant type 2 diabetes is associated with higher rates of nephropathy. Others are looking at ways to define subtypes of type 2, and people are looking hard for the genes that cause type 2 diabetes. I'm sure that in the next 5-10 years we'll know more, but this is pretty much what we know now. Again, like with type 1 diabetes, what matters most is how we approach the patient clinically. If we feel that someone has type 2 diabetes, I believe in following the ADA guidelines because they're not just looking at glucose; they're looking at the risk factors that would lead us to treat those patients with an SGLT2 inhibitor and/or a GLP-1 receptor agonist. If somebody that you've diagnosed with type 2 diabetes has high-risk characteristics — cardiovascular disease, heart failure, chronic kidney disease — or is at high risk for cardiovascular disease, use one of these agents or both. If a patient is obese or overweight, also consider using agents that help with weight loss. There's more than one thing we can do to help our patients. It's no longer just glucose. It's looking at all of the combined features present in an individual. We look at all of the features present in a patient with diabetes and treat them based on how they're doing at the moment and how they progress over time. I think type 2 diabetes has become much easier to treat now that we have so many very effective agents for its treatment. When I first started training, all we had was sulfonylurea agents and insulin. We've come a long way from 1995 when metformin was finally approved in the United States. My hope is that we can diagnose people early, diagnose people with prediabetes, and treat them effectively to ensure that patients don't develop the complications of diabetes. Equally important, I hope we can work to be sure that all people have access to the treatments they need. Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations. https://www.medscape.com/viewarticle/996918?src=soc_yt [4dcv_9hdMBA] |
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