A recent article addressed both the diagnostic challenge and the changing presentation of diabetes mellitus. It included a description of the development of a new microchip for the inexpensive analysis of the autoantibodies that are pathognomonic of type-1 disease (see: Type 1 diabetes can be diagnosed with new microchip). Below is an excerpt from it:
An inexpensive, portable, microchip-based test for diagnosing type-1 diabetes could improve patient care worldwide and help researchers better understand the disease, according to the device’s inventors at the Stanford University School of Medicine....The handheld microchips distinguish between the two main forms of diabetes mellitus, which are both characterized by high blood-sugar levels but have different causes and treatments. Until now, making the distinction has required a slow, expensive test available only in sophisticated health-care settings....Better testing is needed because recent changes in who gets each form of the disease have made it risky to categorize patients based on their age, ethnicity or weight, as was common in the past, and also because of growing evidence that early, aggressive treatment of type-1 diabetes improves patients’ long-term prognoses. Decades ago, type-1 diabetes was diagnosed almost exclusively in children, and type-2 diabetes almost always in middle-aged, overweight adults....Now, because of the childhood obesity epidemic, about a quarter of newly diagnosed children have type-2 diabetes. And, for unclear reasons, a growing number of newly diagnosed adults have type-1. Type-1 diabetes is an autoimmune disease caused by an inappropriate immune-system attack on healthy tissue....The disease begins when a person’s own antibodies attack the insulin-producing cells in the pancreas. The auto-antibodies are present in people with type-1 but not those with type-2, which is how tests distinguish between them....The old, slow test detected the auto-antibodies using radioactive materials, took several days, could only be performed by highly-trained lab staff and cost several hundred dollars per patient. In contrast, the microchip uses no radioactivity, produces results in minutes, and requires minimal training to use. Each chip, expected to cost about $20 to produce, can be used for upward of 15 tests.
It used to be the case that type-1 diabetes with an autoimmune etiology was diagnosed in childhood and type-2 disease was diagnosed in older adults. This latter disease was often referred to as adult-onset diabetes. The age of the patient thus took the physician most of the way to the diagnosis. Now and due to the epidemic of childhood obesity, children are developing type-2 disease and some adults, for unknown reasons, are developing autoimmune disease. Type-1 and type-2 diabetes can be differentiated using an analysis for pancreatic islet cell autoantibodies but the test is slow and expensive (see: Autoantibodies in Diabetes). Researchers at Stanford are now developing a micro-chip based test for autoantibodies that is reportedly both fast and inexpensive.
Here are some additional comments about the microchip-based test and the diagnosis of diabetes from a Stanford web site (see: Researchers invent nanotech microchip to diagnose type-1 diabetes):
The microchip relies on a fluorescence-based method for detecting the antibodies. The team’s innovation is that the glass plates forming the base of each microchip are coated with an array of nanoparticle-sized islands of gold, which intensify the fluorescent signal, enabling reliable antibody detection....In addition to new diabetics, people who are at risk of developing type-1 diabetes, such patients’ close relatives, also may benefit from the test because it will allow doctors to quickly and cheaply track their auto-antibody levels before they show symptoms. Because it is so inexpensive, the test may also allow the first broad screening for diabetes auto-antibodies in the population at large. “The auto-antibodies truly are a crystal ball,” [the inventor of the chip] said. “Even if you don’t have diabetes yet, if you have one auto-antibody linked to diabetes in your blood, you are at significant risk; with multiple auto-antibodies, it’s more than 90 percent risk.”