Dokument: Adult-onset type 1 diabetes: early detection, differential diagnosis, and emerging disease-modifying therapies
| Titel: | Adult-onset type 1 diabetes: early detection, differential diagnosis, and emerging disease-modifying therapies | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=72668 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20260323-120352-7 | |||||||
| Kollektion: | Publikationen | |||||||
| Sprache: | Englisch | |||||||
| Dokumententyp: | Wissenschaftliche Texte » Artikel, Aufsatz | |||||||
| Medientyp: | Text | |||||||
| Autoren: | Wagner, Robert [Autor] Reger-Tan, Susanne [Autor] Füchtenbusch, Martin [Autor] Hummel, Michael [Autor] Miszon, Martin [Autor] Pfützner, Andreas [Autor] Wiesner, Tobias [Autor] | |||||||
| Dateien: |
| |||||||
| Stichwörter: | Diagnostic algorithm , Screening , Therapeutic perspectives , Type 1 diabetes , Adult-onset type 1 diabetes | |||||||
| Beschreibung: | Adult-onset type 1 diabetes (T1D) likely exceeds childhood-onset in absolute numbers, yet many cases are underestimated due to misclassification as type 2 diabetes. This pragmatic review synthesizes current evidence on epidemiology, pathophysiology, diagnosis, and early disease-modifying therapy in adults. Incidence data from 32 countries indicate that adults account for a median 42% of new T1D diagnoses. Autoimmunity follows the pediatric, HLA-restricted paradigm, but β-cell dysfunction appears slower, reflected by measurable C-peptide for years. Misdiagnosis delays insulin initiation, increases ketoacidosis risk, and forfeits opportunities for β-cell–sparing interventions. We present a four-step diagnostic algorithm integrating an islet autoantibody panel with a fasting or random C-peptide–to-glucose ratio, and highlight red-flag scenarios warranting repeat testing. We also propose a hypothetical, risk-enriched four-step pathway to identify presymptomatic T1D in adults that begins with a higher HbA1c trigger, uses enrichment to raise pretest probability, and reserves full autoantibody testing for high-probability individuals. Given low prevalence and false-positive risk, this pathway needs prospective validation before routine care. We review adult and adolescent evidence for targeted immunomodulators, including teplizumab, abatacept, rituximab, low-dose anti-thymocyte globulin, ustekinumab, golimumab, baricitinib and alefacept, as well as β-cell–directed agents such as verapamil and imatinib, and discuss emerging HLA- and autoantibody-defined endotypes that may predict response. Collectively, current evidence supports routine autoimmune diabetes screening in adults with new-onset diabetes. | |||||||
| Rechtliche Vermerke: | Originalveröffentlichung:
Wagner, R., Füchtenbusch, M., Hummel, M., Miszon, M., Pfützner, A., Reger-Tan, S., & Wiesner, T. (2025). Adult-onset type 1 diabetes: early detection, differential diagnosis, and emerging disease-modifying therapies. Diabetes Research and Clinical Practice, 231, Article 113047. https://doi.org/10.1016/j.diabres.2025.113047 | |||||||
| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 23.03.2026 | |||||||
| Dateien geändert am: | 23.03.2026 |
