Type 1 or type 2 diabetes? What's in a name. The controversy and conundrum of diabetes type in youth and the public health impact

Buryk, Melissa (2014) Type 1 or type 2 diabetes? What's in a name. The controversy and conundrum of diabetes type in youth and the public health impact. Master Essay, University of Pittsburgh.

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Abstract

Type 1a diabetes (T1D) is an autoimmune condition characterized by islet cell destruction and progressive insulin deficiency, characteristically present with weight loss and thin habitus. With the rising incidence of obesity over the past several decades, the prevalence of obesity at onset of diabetes has increased. Furthermore, the incidences of both Type 2 diabetes (T2D) and T1D have significantly increased in recent years. Therefore, it has become increasingly difficult to distinguish between T1D and T2D at onset of disease in children with several hypotheses available to attempt to link these diagnoses with the theory that obesity itself may be playing a role in the increasing onset of diabetes in children. The distinction between T1D and T2D may not be of initial therapeutic importance, and may not even be a valid classification system. However, the differentiation is of importance to public health because it helps to characterize the co-morbidities of the rising obesity epidemic and plan for future health care delivery and the costs of these conditions and their comorbidities rise. With obesity leading to diabetes, improved public health efforts to stem the obesity epidemic may ultimately be able to decrease the long-term costs to the healthcare system resulting from increasing obesity epidemic. Diabetes associated autoantibodies are the traditional method used to differentiate T1D from T2D. However, patients with phenotypic T1D may be negative for autoantibodies at disease diagnosis with commonly used testing methods. Therefore, absence of antibodies, even in the presence of obesity, does not necessarily indicate the presence of T2D. We have used other markers of autoimmunity (diabetes associated T cell responses) and HLA typing to identify additional autoimmune findings in antibody negative, insulin-requiring diabetes. This enhances the argument that many autoimmune children may be classified with T2D due to the presence of obesity and evidence of insulin resistance and that autoantibody negative diabetes (and pediatric diabetes in general) may is heterogeneous, with our current classification system not adequate to fully characterize this condition.

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Details

Item Type:	Other Thesis, Dissertation, or Long Paper (Master Essay)
Status:	Unpublished
Creators/Authors:	Creators Email Pitt Username ORCID Buryk, Melissa
Contributors:	Contribution Contributors Name Email Pitt Username ORCID Thesis advisor Finegold, David N. dnf@pitt.edu DNF UNSPECIFIED Committee Member Becker, Dorothea dbecker@pitt.edu DBECKER UNSPECIFIED
Date:	August 2014
Date Type:	Publication
Defense Date:	8 August 2014
Submission Date:	6 August 2014
Access Restriction:	No restriction; Release the ETD for access worldwide immediately.
Publisher:	University of Pittsburgh
Institution:	University of Pittsburgh
Schools and Programs:	School of Public Health > Multidisciplinary MPH
Degree:	MPH - Master of Public Health
Thesis Type:	Master Essay
Refereed:	Yes
Uncontrolled Keywords:	Pediatric, diabetes, obesity, autoimmunity
Date Deposited:	12 Aug 2015 18:24
Last Modified:	04 Jul 2023 11:56
URI:	http://d-scholarship.pitt.edu/id/eprint/22638

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