The Impact of Type 1 Diabetes Misclassification in Adolescents

Laboratory assistant with a sample of blood in a test tubeHow common are misclassifications of type 1 diabetes mellitus in adolescents, and what effects do they have on a patient’s risk of related complications? The study, "Prevalence and impact of initial misclassification of pediatric type 1 diabetes millitus," led by researchers at the University of South Carolina set out to explore this question.

The researchers were interested in the extent to which adolescents with type 1 diabetes were initially misclassified as having type 2 diabetes mellitus or unspecified diabetes. They also explored the impact of these misclassifications on patients’ risks for diabetic ketoacidosis (DKA), neuropathy, nephropathy, and cardiovascular problems.

The study authors relied on an 11-year dataset. Participants were South Carolina State Medicaid enrollees under the age of 18 who had a diagnosis of type 2/unspecified diabetes mellitus or type 1 diabetes mellitus over the course of 2 visits (15 days apart). The participants were examined for a median of 7 years.

The researchers used survival analysis to examine the association between a misclassification and diabetic complications (after accounting for comorbidities and other individual risk factors). Of the 1,130 adolescents in the study, 669 (59.2%) were consistently diagnosed with type 2 or unspecified diabetes mellitus, while 205 were consistently diagnosed with type 1 diabetes mellitus. The remaining 256 patients were misclassified (22.7%).

According to the results, all of the children who were accurately diagnosed with type 1 diabetes were treated with insulin, compared with only 73% of the misclassified group. When compared with the participants who were appropriately diagnosed with type 2 diabetes, those appropriately diagnosed with type 1 diabetes had earlier development of DKA. However, being in the misclassified group was associated with earlier development of DKA, neuropathy, and nephropathy.

The researchers concluded that it is sometimes difficult to properly classify pediatric diabetes, and that failure to appropriately diagnose type 1 diabetes mellitus in children may increase their risk of substandard treatment and related complications.

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