Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-15

were more like those of type 1 diabetes with prolonged destruction of beta cells (22). Since the diagnosis has implications for treatment, it is important to use clinical features to help distinguish these patients from those with type 2 diabetes.

In a retrospective study of 102 people positive for GAD, at least two of the five following clinical features were present (21): 1. <50 years of age. 2. Acute symptoms at diagnosis. 3. Body mass index (BMI) <25 kg/m 2 .

4. Personal history of autoimmune disease. 5. Family history of autoimmune disease.

Patients with LADA generally do not have an absolute insulin deficiency at diagnosis, but 80% will require insulin within five years after diagnosis (23). There is debate as to the best time for insulin initiation, whether at the time of diagnosis or at the onset of acute symptoms with the failure of oral agents. Type 2 diabetes Type 2 diabetes is characterized by a combination of either predominant insulin resistance and abnormal insulin secretion or predominant insulin deficiency and insulin resistance (1,24). While the presence of insulin resistance (from obesity, high-fat diets, inactivity, aging or a genetic basis) is well established, beta cell dysfunction is also always present, occurring early and likely predating hyperglycemia (7,24). When type 2 diabetes is clinically present in children and adolescents, both insulin sensitivity and beta cell function are impaired, and hepatic glucose output is increased (25). Beta cell function impairment seems to be of greater magnitude than insulin sensitivity when compared to a non-diabetic obese group of people (25). Type 2 diabetes is recognized as a disease that may progress from prediabetes to diabetes at a variable rate. Genetic Considerations in Type 2 diabetes (5) Type 2 diabetes is a polygenetic and multifactorial condition. More than 70 genes predisposing to type 2 diabetes have been identified. However, their contribution is considered in the context of environmental factors, such as physical inactivity, obesity and