Jaimes ESMIs pick, diabetes, From shutterstock, 218_free

Can clinical features differentiate individuals with type 1 from type 2 diabetes?

ESMI's pick for December 2015

This month the honour goes to Jaime Peters for her publication "Can clinical features be used to differentiate type 1 from type 2 diabetes? A systematic review of the literature" in BMJ Open. 

We asked Jaime to give us some background and context to her paper:

"This work came about through discussions with clinical experts on the difficulty of classifying individuals as having type 1 or type 2 diabetes. Evidence suggests that 7-15% of individuals with diabetes are misclassified, and so receive inappropriate treatment. In the absence of evidence-based guidance on what clinical features can help classification, type 1 diabetes has been considered the likely diagnosis for young, slim individuals, whereas type 2 diabetes is more likely in older people who are obese. However, with increases in the prevalence of obesity leading to more cases of type 2 diabetes being seen in younger individuals, classification of type 1 and type 2 diabetes is becoming even less certain.

To address this problem Dr Bev Shields lead a successful proposal to the NIHR Research for Patient Benefit funding panel which included a systematic review of the literature to evaluate the performance of clinical features, such as age and BMI, to differentiate individuals with type 1 from type 2 diabetes.

After reviewing almost 11,000 titles and abstracts, we found just 11 studies that were eligible for our systematic review. There were considerable differences across the studies, however age at diagnosis of diabetes and time to insulin treatment after diagnosis were consistently the better performing clinical features reported in the studies. As for BMI, although used in clinical practice, it was not found to be useful when added to age at diagnosis and time to insulin treatment to distinguish type 1 from type 2 diabetes. These clinical features are similar to the Royal College of General Practitioners (RCGP) NHS Diabetes classification guidelines for classifying type 1 diabetes which are based on consensus expert opinion (age at diagnosis <35 years and received insulin treatment within 6 months of diagnosis). We therefore concluded that the RCGP guidelines should be used until further good-quality studies, preferably looking at individuals close to diagnosis, are carried out.

We are now conducting a systematic review to evaluate whether autoantibody testing close to diagnosis can help to differentiate individuals with type 1 from type 2 diabetes. The protocol can be found here".

Congratulations to Jaime and colleagues in ESMI for their current and ongoing work to classify individuals with type 1 or type 2 diabetes.


Browse the other ESMI's picks