Classification Categories and Clinical Spectrum of Diabetes Mellitus in Young: An Indian Tertiary Care Center Experience

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Abstract Background: Younger people are being afflicted with the pandemic of diabetes mellitus (DM). Although DM is conventionally classified based on insulin requirement at a primary level, there is a large spectrum of DM in young. All subtypes of DM have their exclusive management strategy and ‘one size fits all’ strategy can lead to adverse clinical outcomes. Hence, all efforts should be put to differentiate individual entities of DM subtypes by applying appropriate clinical and laboratory tools. Materials and Methods: This observational cross-sectional study was conducted between December 2020 to March 2022 in 30 patients of age <35 years with established diagnosis of DM as per American Diabetes Association (ADA) criteria. Their clinical profile, Anti-GAD-65 Ab, abdominal imaging and genetics tests were used for the classification of DM and studying their clinical peculiarities. Results: The mean age of patients was 30.53 ± 5.6 years and the group was male predominant, consisting of 22 (73.33%) males and 8 (26.67%) females with a ratio of 2.75:1. The main subtypes of DM detected in this study after application of the study protocol was as follows type 1 DM (T1DM) in 12 (40%), type 2 DM (T2DM) 11 (36%), pancreatogenic DM 3 (10%), maturity-onset diabetes of the young (MODY) 1 (3.3%), Cushing’s syndrome 1 (3.3%) out of 30 patients, and 1 (3.3%) patient could not be classified. The most common comorbidity noted was primary hypertension in 3 (10.0%), followed by primary autoimmune hypothyroidism in 1 (3.3%). All patients having primary hypertension had T2DM, whereas primary autoimmune hypothyroidism was seen in a T1DM patient. T1DM had higher glycosylated hemoglobin (HbA1c) levels (average HbA1c >8.9%) and ketosis 10 (83%) and 6 (50%) out of 12 patients, respectively, as compared to T2DM patients in which lower HbA1c levels (average HbA1c <9%) and lower incidence of ketosis seen in 3 (27.2%) and 2 (18.1%) out of 11 patients, respectively. Conclusion: Various clues in history, clinical examination, and laboratory evaluation help in classification and establishing diagnosis among young DM patients. Apart from T1DM and T2DM, other subtypes of DM also need to be considered in young DM patients.