This article was written for the practising primary care clinician, who may occasionally take care of a patient with diabetes who doesn’t seem to fit into our typical diabetes classification paradigm. It is not a comprehensive review of the topic for the expert practising endocrinologist.
LADA is a slowly progressive form of type 1a diabetes, and while it may not be distinct from type 1 diabetes, it has certain autoimmune and phenotypic features that distinguish it from childhood type 1 diabetes. Ketosis prone diabetes (KPD) is not simply type 2 diabetes presenting with ketoacidosis. This group of patients is still poorly understood, and much work needs to be done in furthering our understanding of the basic pathophysiology of this heterogeneous group of diabetes. Emerging metabolomics data suggest that in individuals within certain subsets of KPD, a distinctive novel pathogenic process of defective energy production and ketosis may be at play.
Given space limitations, we were unable to describe specific populations with monogenic diabetes, but we hope that our focused discussion of HNF1A monogenic diabetes will stimulate consideration of this type of diabetes.
We agree that regional variation and location of practice are highly relevant. For example, in our hospital, which serves a large, underserved, heterogeneous urban population, ketosis-prone diabetes is the most common reason for admission to the intensive care unit with ketoacidosis. Type 1a diabetes is less common in our particular setting.
Naturally, diet and lifestyle modification form the cornerstone of all diabetes therapeutics. We acknowledge that controversies surrounding diabetes classification continue to exist, but recognition of a possible atypical diabetes phenotype is an important part of primary diabetes care.