I often hear people say that their doctors insist they don’t have Type 1 diabetes/LADA, saying instead that they have Type 2 diabetes; insist that only children and young adults get Type 1 diabetes; or insist that that the person with adult-onset Type 1 diabetes does not need to be treated with insulin. Here are the actual facts from experts in the field and diabetes governing bodies:
If a person has been diagnosed with diabetes and is positive for any one autoantibody, the person has Type 1 diabetes. From the ADA Standards of Care in Diabetes (2023): Type 1 diabetes is due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency, and includes latent autoimmune diabetes of adulthood; all forms of diabetes mediated by autoimmune β-cell destruction are included under the rubric of Type 1 diabetes. The American Association of Clinical Endocrinologists (AACE) now suggests that autoantibody testing be performed to differentiate between Type 1 diabetes and non-autoimmune diabetes (Type 2, MODY, etc.).
Adults represent the majority of new-onset Type 1 diabetes; recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults (R David Leslie et al. Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care 2021;44:2449-2456). Also, "Adult-onset type 1 diabetes is frequently misdiagnosed as type 2 diabetes, leading to inappropriate care. Emerging data suggest that up to 62% of type 1 diabetes cases develop after age 20 years" (Annals of Internal Medicine "Age at Diagnosis in U.S. Adults With Type 1 Diabetes," 26 September 2023).
Insulin is the correct treatment for people with Type 1 diabetes, according to a 2021 consensus report by the ADA/EASD: “Most people with Type 1 diabetes should use [insulin] regimens that mimic physiology as closely as possible, irrespective of the presentation.” Regarding adjunct therapies (metformin, pramlintide, GLP-1s, SGLT inhibitors), the authors state, “before these drugs are prescribed, insulin therapy should be optimized.” In other words, the initial treatment of a person with adult-onset Type 1 diabetes should not be to treat them as if they have Type 2 diabetes; the standard initial therapy is insulin (and then adjunct therapies can be considered). (The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (Diabetes Care, September 30, 2021)).
If your doctor promotes one of these myths, you can ask them why they are contradicting the standards of the medical governing bodies (and cite the references).
