Idiopathic type 1 diabetes in Dallas, Texas: a 5-year experience.
OBJECTIVE
To describe the clinical course of individuals with idiopathic type 1 diabetes after a mean of 5 years from diagnosis and to compare glycemic control between those treated with diet and/or oral agents and those treated with insulin at follow-up.


METHODS
Medical records of patients with new-onset diabetes, who presented with unprovoked diabetic ketoacidosis, were reviewed. A total of 54 of these individuals were traceable and had relevant data collected within the past 2 years. All patients had nonsusceptibility HLA haplotypes and no serological evidence of autoimmune type 1 diabetes. Most of these patients were male (41 men and 13 women), were non-Caucasian, were obese at the time of diagnosis (BMI 31.6 +/- 6.3 kg/m(2)), reported weight loss (12.8 +/- 9.8 kg), had a family history of type 2 diabetes, and had acanthosis nigricans. At follow-up, 33 patients were still taking insulin and 21 were on diet and/or oral-agent therapy.


RESULTS
Both treatment groups were similar in clinical presentation and demographics at diagnosis. After 4.8 +/- 1.6 years of follow-up, the 33 patients that were receiving insulin had a lower HbA(1c) than the 21 patients who were using therapies other than insulin (7.8 +/- 2.4 vs. 11.1 +/- 3.5%, P = 0.009; 95% CI 1.0-6.5%). There was a high correlation between change in weight and change in HbA(1c) at follow-up (r = 0.45, P < 0.001, n = 54). There were no differences in the rate of diabetes complications or in the episodes of recurrent diabetic ketoacidosis.


CONCLUSIONS
Idiopathic type 1 diabetes occurs more frequently in male African-American patients but also occurs in other ethnic groups. Patients with idiopathic type 1 diabetes who continued to use insulin had better glycemic control than patients using therapies other than insulin. Regained weight is a good clinical marker for improvement in glycemic control. Individuals with this type of diabetes should not be switched to therapies other than insulin.
Piñero-Piloña
A
A
Department of Internal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
Litonjua
P
P
Aviles-Santa
L
L
Raskin
P
P
D000328:Adult; D001741:Black or African American; D015992:Body Mass Index; D001835:Body Weight; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000235:genetics; D016883:Diabetic Ketoacidosis / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino; D006801:Humans; D007198:Indians, North American; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D009765:Obesity; D012189:Retrospective Studies; D013781:Texas; D015431:Weight Loss; D044465:White People
D006442:Glycated Hemoglobin; D007328:Insulin