Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Not Always Typical: Update on Diabetes Classification

Video Transcription

Video Summary

Dr. Jana McGill reviews how diabetes classification has expanded beyond “type 1 vs type 2” to an etiologic framework that includes autoimmune (type 1), type 2, monogenic/syndromic, and pancreatic (“type 3c”) diabetes. Correct classification matters because risks and treatments differ—such as DKA and other autoimmune disease in type 1, or cardiovascular/liver/kidney risks in insulin-resistant type 2, and nutritional deficiencies in pancreatic diabetes.<br /><br />She emphasizes that type 1 diabetes commonly occurs in adults (mean onset ~24 years; 37% diagnosed after 30), and antibodies can disappear over time. Testing all four autoantibodies early improves accuracy; GAD is most persistent but least specific, especially at low titers.<br /><br />Type 2 diabetes is heterogeneous. Large Scandinavian data identified clusters (autoimmune/LADA-like, severe insulin-deficient, severe insulin-resistant, mild obesity-related, mild age-related) with differing complication risks; severe insulin resistance strongly predicts kidney disease. Genetic patterns also map to insulin resistance vs beta-cell failure.<br /><br />Pancreatic diabetes is underrecognized, varies globally, and can follow pancreatitis or pancreatic loss. Suggested evaluation includes history/imaging, low lipase (as a marker of reduced pancreatic mass), stool elastase for exocrine insufficiency, and fat-soluble vitamin testing.<br /><br />Monogenic diabetes requires genetic panels because treatment can differ dramatically (e.g., no treatment for GCK-MODY; sulfonylurea-responsive forms). She highlights HNF1B (RCAD) with renal cysts plus diabetes and associated lab clues.

Asset Subtitle

Janet McGill

Meta Tag

Module DKD

Speaker Janet McGill

Keywords

diabetes etiologic classification

type 1 diabetes in adults

autoantibody testing (GAD IA-2 ZnT8 insulin)

type 2 diabetes subtypes and clustering

severe insulin resistance and kidney disease risk

pancreatogenic diabetes (type 3c) evaluation

monogenic diabetes (MODY) genetic testing and treatment