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Author: Dalia Hawwass, MD, University of Nevada
School of Medicine, Class of 2013
Flatbush Diabetes or Idiopathic Type-1 Diabetes or Atypical
Diabetes is an emerging subtype of Diabetes Mellitus that is
prevalent in obese, middle age, minority patients, with a higher
male predominance. It has a unique presentation with features of
both type 1 and type 2 diabetes.
We present a case of a 43 y/o African American male who
initially presented with DKA to our hospital with HbA1c of 16.5
with a perplexing subsequent clinical progression. After initial
resolution of DKA and appropriate new onset diabetes mellitus care,
the patient was discharged on long acting and pre-meal insulin.
Initial labs drawn on his first outpatient visit yielded a fasting
blood glucose of 390 mg/dL, C- peptide level of 2.38, and negative
for Anti-islet cell antibodies and anti-glutamic acid
Despite the patient being poorly compliant due to an undue fear
of needles and recent onset blindness, he clinically improved over
the course of one year out patient follow up. The patient had a
significant drop in his HbA1c to < 6.5 during this period. At
present he surprisingly continues to be off insulin therapy with
Flatbush Diabetes also officially known as Atypical Diabetes
usually presents with typical signs and symptoms of Type 1
Diabetes, such as diabetic ketoacidosis, but clinically progresses
as Type 2 Diabetes with sustained glycemic control observed through
oral hypoglycemic agents after the initial resolution of DKA. In
contrast to Type-1 Diabetes, these patients with what we call
diabetes type 1.5, otherwise known as idiopathic Type-1 Diabetes,
do not form autoantibodies, have normal levels of C-peptide and can
spontaneously undergo remission without long term
insulin-independence. These patients typically have unintentional
weight loss in the follow-up period.
Primary care physicians must be able to recognize such a blended
clinical picture for appropriate diagnosis, management and
counseling patients with atypical diabetes.
February 2014 Issue of IMpact