Type I (insulin dependent) XXXX : a disease of slow clinical onset?

@entity1 @entity2011 @entity6 @entity1723 @entity413
Type I (insulin dependent) @entity6 is usually believed to present acutely and it is assumed that metabolic decompensation is sudden. In a prospective family study, however, 10 of 13 subjects developing the disease showed progressive or intermittent development of hyperglycaemia over many months and the others had non-specific symptoms over a long period. All were first degree relatives of a @entity1 with @entity1723 ; 10 were siblings (aged 5-24) and three were parents (aged 45-58). All possessed HLA-DR4 or DR3, or both, and all but two had been positive for islet cell antibodies for six to 86 months before diagnosis. Ten had non-specific symptoms for two to 14 months before the onset of thirst and @entity2011 ; one remained asymptomatic even when insulin became necessary. Six subjects had an oral @entity413 tolerance test before clinical onset, of whom five were @entity6 by World Health Organisation criteria four, four, six, seven, and 21 months before insulin was needed. Nine showed random blood @entity413 concentrations above the 97.5th centile (6.3 mmol/l) six to 34 months (median 12) before diagnosis. Two others had a @entity413 tolerance test result compatible with @entity6 but had not reached the stage of needing insulin. Hyperglycaemia is often of insidious onset in @entity1723 , even in @entity1 and young adults. Diagnosis will inevitably be late if considered only when acute symptoms of thirst and @entity2011 develop.
