The Various Faces of Diabetes in the Young

Fajans, Stefan S.; Floyd, John C.; Tattersall, R. B.; Williamson, Joseph R.; Pek, Sumer; Taylor, Charles I.

doi:10.1001/archinte.1976.03630020048011

Cited by 50 publications

(6 citation statements)

References 34 publications

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“…Metabolic heterogeneity also exists in patients with chemical diabetes, and glucose intolerance in this situation may be associated with either insulin deficiency or insulin resistance [8,13]. Furthermore, it has been suggested that the patients with chemical diabetes who progress to insulin requiring diabetes may be the ones in whom insulin deficiency was the initial lesion [13][14][15]. A possible corollary to this observation is the fact [17] that 13 of 20 (65%) of recently diagnosed patients with relatively mild diabetes at the onset, and positive pancreatic islet cell antibodies, progressed to insulin-requiring diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, it is obvious that the above conclusions are based upon generalizations concerning the metabolic characteristics of patients with chemical diabetes -specifically, that their mild glucose intolerance is associated with a loss of insulin sensitivity, without a primary defect in the insulin secretory response to oral glucose. It is apparent that not all patients with chemical diabetes share these metabolic characteristics [8,[13][14][15] and that the glucose intolerance of some proportion of patients with chemical diabetes is associated with a defect in the plasma insulin response to glucose. As such, these patients may well represent the individuals who progress to overt diabetes [8,10,[13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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An attempt to define the nature of chemical diabetes using a multidimensional analysis

1979

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The relationship between chemical diabetes and overt diabetes in 145 nonobese adult subjects has been examined. The degree of glucose intolerance, insulin response to oral glucose, and insulin resistance in normal subjects and patients with nonketotic diabetes were first determined. These variables were then analyzed by a computer program which permits direct visualization of the threedimensional shape of the data set. The picture obtained was that of a boomerang with two wings and a fat middle. The patients were then divided into three groups (normal, chemical diabetes, overt diabetes) on the basis of their oral glucose tolerance. Two-dimensional views of the relationship between the metabolic variables in these subjects resembled the initial three-dimensional image, i.e., a central core with two wings going off in opposite directions. The two wings represented patients with chemical diabetes and overt diabetes, respectively. Following this, the patients were reclassified on the basis of all three metabolic variables (plasma glucose response to oral glucose, plasma insulin response to oral glucose, and degree of insulin resistance) by means of a computer classification which employed a cluster analysis technique. This again resulted in the definition of three groups, in which there was a divergence between subjects classified as having chemical diabetes as contrasted to overt diabetes. This apparent separation between subjects with chemical and overt diabetes may explain why patients with chemical diabetes rarely develop overt diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An attempt to define the nature of chemical diabetes using a multidimensional analysis

1979

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“…By serial testing of young members of families with MODY, it can be demonstrated that there may be very slow progression from normal to impaired glucose tolerance; from impaired to diabetic glucose tolerance with normal fasting plasma glucose levels (up to 18 years); and no progression or very slow progression from that state to fasting hyperglycemia (up to 27 years) (Fajans 1982;1985;Fajans, Floyd, Tattersall, Williamson, Pek and Taylor 1976;Fajans, Cloutier and Crowther 1978). Other MODY have fasting hyperglycemia and/or more rapid progression from an early age (Fajans, Cloutier and Crowther 1978;Fajans 1985).…”

Section: Definition and Phenotypic Expression Of Modymentioning

confidence: 99%

MODY - A Model for Understanding the Pathogeneses and Natural History of Type II Diabetes

Ss¹

1987

Horm Metab Res

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“…Heterogeneity in diabetes mellitus is well recognized [1,2] as is reflected in the recent classification of the National Diabetes Data Group and World Health Organization [3,4]. Many patients with Type 2 diabetes are treated with insulin to control hyperglycaemia, and although they are not prone to spontaneous ketosis, ketoacidosis can occur in Type 2 diabetes with severe intercurrent illness or other stress.…”

mentioning

confidence: 99%

C-peptide measurement in the differentiation of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus

Katzeff¹,

Savage²,

Barclay-White³

et al. 1985

Diabetologia

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To determine whether individual subjects with Type 1 (insulin-dependent) diabetes or Type 2 (non-insulin-dependent) diabetes, who are treated with insulin, could be reliably distinguished, C-peptide concentrations and urinary C-peptide excretion were measured in 10 Caucasoids and 10 Pima Indians. All the subjects had developed diabetes before 21 years of age and were receiving insulin treatment. Fasting C-peptide concentrations were significantly higher in the Pima Indians (0.73 +/- 0.17 versus 0.02 +/- 0.01 nmol/l in Caucasoids; p less than 0.001), but there were slight overlaps in individual values. Urinary C-peptide excretion, an index of 24-h-insulin excretion, was also higher in the Pima Indian group (27.6 +/- 1.85 versus 0.72 +/- 0.18 pmol/min in Caucasoids; p less than 0.001) and there was no overlap in the individual values between the groups. The Pima Indians with early onset diabetes have been previously shown to have Type 2 diabetes, and the Caucasoids with an early onset are most likely to have Type 1 diabetes. These results suggest that distinction between these two major types of diabetes can be made effectively by using C-peptide measurements provided that overt renal disease is absent. This differentiation between insulin-treated patients will be useful for a variety of research applications and possibly in making clinical management decisions.

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The Various Faces of Diabetes in the Young

Cited by 50 publications

References 34 publications

An attempt to define the nature of chemical diabetes using a multidimensional analysis

An attempt to define the nature of chemical diabetes using a multidimensional analysis

MODY - A Model for Understanding the Pathogeneses and Natural History of Type II Diabetes

C-peptide measurement in the differentiation of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus

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