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Carla Greenbaum Part 8, Adult Onset Diabetes

In part 8 of this Exclusive Interview, Dr. Carla Greenbaum talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the diagnosis of diabetes in adults, as differentiated from diagnosis in children.

Carla Greenbaum, MD is Director of the Diabetes Research Program at Benaroya Research Institute at Virginia Mason in Seattle, WA.

Transcript of this video segment:

Steve Freed: You know it used to be called juvenile diabetes. And we changed the name because we’re seeing more people with adult onset diabetes and I had a patient come into my pharmacy with a prescription for sulfonylurea and I said, “When were you diagnosed?” And he said, “About 15 minutes ago. I just came from the hospital.” And I said, “How did they diagnose?” And he said, “Well, I went in for a physical and my blood sugar was 675.” and I said, “So wait, let me get this straight…”

Carla Greenbaum: They’re giving you a sulfonylurea.

Steve Freed: I sent him back to the hospital.

Carla Greenbaum: Good for you.

Steve Freed: You know so what about adult onset diabetes?

Carla Greenbaum: Yeah, that’s a great question. So among the other things we’ve learned over the years is that you know the paradigm (it was primarily developed in the 80’s, right?) of type 1 and type 2 has been very helpful, but in general what that is, is we’re putting a box in a continuous variable in a category. And we know that immune mediated diabetes can occur at any age and it is often misdiagnosed in adults because people are so used to people having type 2 diabetes. And of course now since we don’t have other therapies, the goal of all therapies is to reduce your glucose so it’s not so critical to know. But the most interesting thing we’ve been learning recently is that if you were diagnosed with diabetes as a child, type 1, as compared to adult, you have a very different clinical course. So people who are diagnosed as children have a much more rapid fall in their insulin secretion. They lose beta cells much more rapidly. We now know certain immune and genetic characteristics are different. So it’s certainly possible that someday we will change the name just like in arthritis. So there’s juvenile arthritis and there’s rheumatoid arthritis that’s in adults. They’re actually two different diseases. There are two different therapeutic pathways. Drugs are developed separately. We may get there, so it depends whether you’re a lumper or a splitter, but you’re correct. Certainly immune disease can happen at any age.

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