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Diabetes of Unclear Type in an Adolescent Boy With Multiple Islet-cell Autoantibody Positivity Successfully Managed With Glucagon-like Peptide-1 Receptor Agonist Alone: A Case Report

  • Olivia Z.B. Ginnard
    Correspondence
    Address for correspondence: Olivia Z.B. Ginnard DO, Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 10th Floor, 6701 Fannin Street, Houston, Texas 77030, United States.
    Affiliations
    Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States
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  • Maria J. Redondo
    Affiliations
    Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States
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  • Sarah K. Lyons
    Affiliations
    Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States
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Published:August 02, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.07.006

      Abstract

      Diabetes classification has traditionally considered type 1 and type 2 diabetes as 2 separate entities with different pathogenic mechanisms. However, clinicians and researchers see increasingly more exceptions to this conventional paradigm, leading to a concept of mixed phenotypes in diabetes classification. Herein we report the case of an adolescent with unclear diabetes type due to the presence of obesity, robust endogenous insulin production, multiple islet autoantibody positivity and severe hyperglycemia at diabetes diagnosis that has been successfully treated with liraglutide therapy alone. Our case report highlights the difficulty of diabetes classification and subsequent need for personalized medicine with regard to diabetes management.

      Résumé

      D’après la classification traditionnelle du diabète, le diabète de type 1 et de type 2 sont considérés comme 2 entités distinctes dont les mécanismes pathogéniques sont différents. Toutefois, les cliniciens et les chercheurs voient de plus en plus d’exceptions à ce paradigme traditionnel, qui les font aboutir à un concept de phénotypes mixtes lors de la classification du diabète. Dans le présent article, nous rapportons le cas d’un adolescent atteint d’un type incertain de diabète dû à la présence d’obésité, de production d’insuline endogène, de positivité à de nombreux anticorps anti-îlots et d’hyperglycémie grave au moment du diagnostic du diabète, dont le traitement par liraglutide seul s’est avéré efficace. Notre observation met en évidence la complexité de la classification du diabète et, par conséquent, la nécessité d’appliquer la médecine personnalisée lors de la prise en charge du diabète.

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