Winning Abstracts from the 2013 Medical Student Abstract Competition: Flatbush Diabetes or Idiopathic Type-1 Diabetes or Atypical Diabetes
Author: Dalia Hawwass, MD, University of Nevada School of Medicine, Class of 2013
Flatbush Diabetes or Idiopathic Type-1 Diabetes or Atypical Diabetes is an emerging subtype of Diabetes Mellitus that is prevalent in obese, middle age, minority patients, with a higher male predominance. It has a unique presentation with features of both type 1 and type 2 diabetes.
We present a case of a 43 y/o African American male who initially presented with DKA to our hospital with HbA1c of 16.5 with a perplexing subsequent clinical progression. After initial resolution of DKA and appropriate new onset diabetes mellitus care, the patient was discharged on long acting and pre-meal insulin. Initial labs drawn on his first outpatient visit yielded a fasting blood glucose of 390 mg/dL, C- peptide level of 2.38, and negative for Anti-islet cell antibodies and anti-glutamic acid antibodies.
Despite the patient being poorly compliant due to an undue fear of needles and recent onset blindness, he clinically improved over the course of one year out patient follow up. The patient had a significant drop in his HbA1c to < 6.5 during this period. At present he surprisingly continues to be off insulin therapy with HbA1c<6.5.
Flatbush Diabetes also officially known as Atypical Diabetes usually presents with typical signs and symptoms of Type 1 Diabetes, such as diabetic ketoacidosis, but clinically progresses as Type 2 Diabetes with sustained glycemic control observed through oral hypoglycemic agents after the initial resolution of DKA. In contrast to Type-1 Diabetes, these patients with what we call diabetes type 1.5, otherwise known as idiopathic Type-1 Diabetes, do not form autoantibodies, have normal levels of C-peptide and can spontaneously undergo remission without long term insulin-independence. These patients typically have unintentional weight loss in the follow-up period.
Primary care physicians must be able to recognize such a blended clinical picture for appropriate diagnosis, management and counseling patients with atypical diabetes.