In part 4 of this Exclusive Interview, Kathleen Wyne talks with Diabetes in Control Medical Editor Joy Pape during the AACE 2018 convention in Boston, MA about the irrelevance of age when diagnosing diabetes and the protocol when screening for cardiovascular complications.
Kathleen Wyne MD, PhD, FACE, MACP, FNLA is an endocrinologist and Director of the OSU Adult Type 1 Diabetes Program at The Ohio State University.
Transcript of this video segment:
Pape: Very good. And so, what is the age of the oldest person you have diagnosed with type 1 diabetes?
Wyne: So, earlier this year, I diagnosed a 76-year-old man. But in my training, I participated in the diagnosis of someone who was 92 years old with autoimmune type 1. And the reason I say participated is because I wasn’t the primary person doing the consult who asked the questions, that was actually the fellow who did the consult. But I got to help in the evaluation. So, for me myself, the first one that I thought might be, I would say is 76. But I have seen as old as 92 presenting with autoimmune type 1 diabetes. Let me give you the flip side of that, though: What’s the youngest type 2 I’ve ever seen?
Pape: I don’t know.
Wyne: So, in Texas, we had children as young as two-years-old with type 2 diabetes. So, age does not tell you the type of diabetes. Patients don’t come in with a number on their forehead. You have to use your clinical skills to decide what kind and then do your test to prove that you’re right.
Pape: When do you start screening for microvascular complications in adult onset type 1?
Wyne: So, you know the data we have with type 1 diabetes suggests that microvascular complications don’t start until after at least five years of hyperglycemia. So, the easy answer would be to say five years. But, first of all, you have to put in the context of the patient and any other diseases, comorbidities, risk factors. So, if I have a slender 26-year-old who’s never been sick a day in their life, I’m probably not going to screen for any microvascular complications. If I have a 58-year-old man, odds are he’s got a little bit of hypertension, right? So, I am going to check him out for microalbuminuria – I’m going to look at his lipids carefully. I’m probably not going to do a formal retinal exam; not for at least five years. Do I need to do neuropathy screening at diagnosis? Probably not for a type 1. So, to me the big one is the microalbumin, and that’s a function of age and other comorbidities.