No, it’s not definitive. Circulating autoantibodies are found in non-diabetic individuals, typically several % of the general population, and much much higher in first-degree relatives of T1s. Many of these individuals will never go on to develop T1 though they may be at increased risk. The predictive or diagnostic value of autoantibodies is strongest when 2 or 3 are found, and when they are found at high levels. To be definitive, all individuals with autoantibodies would have to have or develop T1, and that isn’t the case. Instead, they are suggestive of risk and in cases where symtoms are consistent can be used to support a diagnosis of T1. But in the absence of other clinical findings, they would not support such a diagnosis.
If a person is diagnosed as having diabetes (bg > 125 mg/dl fasting, meets criteria) and is antibody positive, the person has Type 1 autoimmune diabetes, and yes it is definitive. DiverDon has been diagnosed as having diabetes, so if DD is antibody positive he has Type 1a.
A test that falsely identifies non-diabetics can not be definitive. Someone with insulin-resistant T2 or gestational diabetes, like the general population, can have circulating autoantibodies in the absence of overt autoimmunity. Like the general population, these individuals are at risk for T1 but not definitively so.
Most clinical guidelines state that autoantibodies are characteristic of or presumptive of T1 because of its likelihood as well as the benefit of preventing DKA vs the risks of insulin therapy. But its just one element of the diagnosis. I have not seen anything as conclusive as you state.
So if by ‘definitive’ you mean ‘the best we have’ then I agree. But if you mean ‘no doubt whatsoever’ then I disagree. Medicine has few absolutes and this is not one of them. The distinction between autoimmune and non-autoimmune D has importance for future treatment and an eventual cure.
Hi DiverDon - at the moment this discussion is kinda speculative. I do think you should get an antibody test done and then this discussion can continue. Without the antibody results, a lot of this is interesting and informative, but ultimately speculative.
I agree. We can make educated guesses, but nobody on a website can diagnose you. I’m not suggesting you were asking us to.I just know that we all like to relate and especially for those of us who were misdiagnosed this is a bit of a hot topic. Today in Walgreen’s I met a woman who is close to me in age, diagnosed around the same time, lost a bunch of weight and oral meds didn’t work when they put her on them assuming as a woman in her 50s she was type 2. I nearly called her Sister!! LOL
Hi Tom: You are right, there are no guarantees in life and I should refer to antibody testing ((glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), and insulinoma-associated (IA-2) autoantibodies) as “the gold standard” but not definitive for identifying if a person who meets the diagnostic criteria for diabetes has Type 1 autoimmune diabetes. Regarding women with gestational diabetes who are antibody positive, autoimmune gestational diabetes is well-recognized in Europe (where in some populations autoimmune GDM represents 40% of all GDM) and more articles about autoimmune GDM are appearing in U.S. diabetes journals. Unfortunately, misdiagnosis of people with adult-onset Type 1 autoimmune diabetes as Type 2, strictly because of age not etiology, sadly remains really common. And I couldn’t agree more that it is important to distinguish between autoimmune and non-autoimmune diabetes, for multiple reasons including appropriate treatment, but ultimately for a cure.
100% agreement then, we just disagreed over a word then, sorry:) Gold standard, you got it. Misdiagnosis is a huge problem. It saddens me that we see so many people come here with a likely case of misdiagnosis that isn’t being considered properly! I actually cringe when people, even doctors and scientists, still talk about T1 as a childhood disease…