Suzuki et al described patients with the rare occurrence of Type 1 diabetes mellitus arising in a setting of long-term Type 2 diabetes. The authors are from Kurashiki, Japan.


Features at onset:

(1)presence of diabetes with a Type 2 phenotype

(2) absence of islet-associated autoantibodies

(3) secretion of endogenous insulin preserved


Later findings (>= 10 years after initial evaluation):

(1) presence of one or more islet-associated autoantibodies

(2) progressive decline in insulin secretory capacity, eventually becoming insulin dependent

(3) HLA-serotype and genotype consistent with Type 1 diabetes


Differential diagnosis:

(1) latent autoimmune diabetes of the adult (see previous section; these patients will have some evidence of autoantibodies during the initial evaluation)


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