Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the Committee on Slowly Progressive Insulin-Dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society
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Diagnostic criteria for slowly progressive insulin-dependent (Type 1) diabetes mellitus (SPIDDM) have been proposed by the Committee on Slowly Progressive Insulin-dependent (type 1) Diabetes Mellitus of the Japan Diabetes Society. Two criteria must be met for definitive diagnosis: the presence of glutamic acid decarboxylase antibodies (GADAb) and/or islet cell antibodies (ICA) at some time during the clinical course of the diabetes, and the absence of ketosis or ketoacidosis at the onset (or diagnosis) of diabetes mellitus and no need for insulin treatment to correct hyperglycemia immediately after diagnosis. It is still unclear whether insulinoma-associated antigen-2 autoantibodies (IA-2Ab), insulin autoantibodies (IAA), or zinc transporter 8 autoantibodies (ZnT8Ab) are essential markers for diagnosis for SPIDDM. Hence, the presence of IA-2Ab, IAA, and ZnT8Ab were excluded from these diagnostic criteria for SPIDDM. Furthermore, ketosis or ketoacidosis can be observed in cases in which SPIDDM is complicated by soft-drink ketosis. Supplementary information for diagnosis include: most SPIDDM patients will need insulin treatment more than 3 months after onset (or diagnosis) of diabetes mellitus and frequently progress to an insulin-dependent state; sometimes, for clinical reasons, early insulin treatment is started when GADAb or ICA are positive both for child and adult-onset cases; GADAb and/or ICA often become negative during the course of the disease; and a small proportion of patients might maintain endogenous beta-cell function more than 10 years after the onset (or diagnosis) of diabetes mellitus, irrespective of the titer of GADAb and ICA.
KeywordsDiagnostic criteria Slowly progressive insulin-dependent (type 1) diabetes mellitus Glutamic acid decarboxylase antibodies Islet cell antibodies Insulinoma-associated antigen-2 antibodies Insulin autoantibodies
In addition to the authors, the following doctors (affiliations at the time) assisted in conducting the nationwide survey, for which we are extremely grateful: Drs K.Aida (Yamanashi Kosei Hospital), Y Akiyama (Hiroshima City Funairi Hospital), Y. Abe (Tokyo Medical and Dental University), M. Ikeda (Yamanashi Hospital of Social Insurance), S.Ishizuka (Chiba Central Medical Center), Y. Ishimaru (Ishimaru Hospital), Y. Sakai (Kitakyushu Municipal Medical Center), H. Ito (Isesaki-Sawa Medical Association Hospital), M. Ito (Akta Medical Center), Y. Ito (Kyosai Centrl Clinic), T. Inamoto (Okubo Hospital), T. Inoshima (Arao Municipal Hospital), K. Imamura (Misato Central General Hospital), Y.Oshima (Health Insurance Naruto Hospital), T.Otsuki (Higashi-Kobe Hospital), E.Ohbu (Seiwakai Nagata Hospital), T. Ogawa (Yokohama Municipal Citizen’s Hospital), N. Ogawa (Shimane University), M. Ohara (Nippon Medical School Hospital), K. Kajita (Gifu University), S. Kaneko (Toho University Omori Medical Center), K. Kamiuchi (Osaka General Hospital of West Japan Railway Company), S. Kawashima (Takayama Red Cross Hospital), Y. Kido (Onomichi Municipal Hospital), Y.Kusunoki (Ehime Prefectural Central Hospital), K. Kubota (Komagome Hospital), K. Koga (Koga Clinic), N. Gocho (Nakano General Hospital Tokyo Medical and Dental University), K. Kobayashi (Fukuoka University Chikushi Hospital), Ta. Saito (Noda Hospital Kobari General Hospital), Ts Saito (Kofu Municipal Hospital), S. Saito (Kyushu University Hospital), M. Sasa (Kyoto University), S. Sato (Koga General Hospital), K. Shimokado (Tokyo Medical and Dental University), S. Suzuki (Osaka National Hospital), A. Takano (Saiseikai Takaoka Hospital), M. Takahashi (Yokohama City University Hospital), K. Taki (Fujiyoshida Municipal Medical Center), S. Takizawa (Kanoiwa General Hospital), N. Takubo (Kitasato University), A. Tatsuta (Mitsui Memorial Hospital), M. Tanaka (Misato Kenwa Hospital), Nob. Tamaki (Tamaki Clinic), Nor. Tamaki (Onna Clinic), N. Tamura (Niigata City General Hospital), M. Tsujino (Tokyo Metropolitan Tama Medical Center), H. Tsuji (Okayama Citizens’ Hospital), A. Tsuruoka (Maehara Clinic), M. Tsuruo (Terasawa Hospital), R. Totani (Totani Naika), R. Nagaike (Miyazaki University), Y. Nakajima (Nippon Medical School), Y. Nagase (Kumiai Kousei Hospital), J. Nakano (Saiseikai Fukushima General Hospital), A. Nakamura (Kobe University), T. Nakamura (Sekiaikai Saganoseki Hospital), M. Nakamura (The University of Tokyo Hospital), K. Namai (Saitama Red Cross Hospital), N. Nishimura (Oe Kyodou Hospital), M. Nemoto (Tokyo Kosei Nenkin Hospital), A. Nozaki (Tsunashimakai Kousei Hospital), K. Nomura (Nomura Clinic), K. Hamazaki (Kaizuka City Hospital), K. Haraguchi (Kofu Jonan Hospital), N. Harii (Koyo Hospial), K. Higashi (Tokorozawa City Citizens’ Medical Center), S. Hidaka (Tsurimi Hospital), Y Hirohata (Hagiwara Central Hospital), T. Fukui (Showa University Hospital), T. Fujita (Fujita Neurological Hospital), S. Futamura (Kajikazawa Hospital), S. Furukawa (Ehime University Hospital), H. Furuya (Nara Medical University), M. Maeda (Saiseikai Sendai Hospital), S. Masuko (Jimbou-cho Metabolism Clinic), R. Matsushita (Heiwadai Hospital), D. Matsuda (Tokyo-Nishi Tokushukai Hospital), M. Miyakoshi (Niigata Prefectural Central Hospital), K. Miyashita (Mitsubishi Mizushima Hospital), K. Murakami (Tamashima Central Hospital), T. Mori (Tsuru City Hospital), H. Moriyama (Kuriyama Central Hospital), M. Moriya (Memuro Public Hospital), K Yajima (Japanese Red Cross Hamamatsu Hospital Tachikawa Hospital), H. Yamaji (Eisei Hospital), D. Yamada (Jiyugaoka Yamada Clinic), T. Yamada (Yamada Clinic), K. Yamamoto (Sumitomo Hospital), T. Yamamoto (Tokyu Hospital), M. Yamamoto (Shimane University), A. Yuhara (Yuhara Clinic), N. Yokomori (Chuo Internal Medicine Clinic), M. Yoshikawa (Tokyo Kyosai Hospital) and Y. Watanabe (Isehara Kyodo Hospital).
Conflict of interest
The authors do not have any conflicts of interests.
Human rights statement and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revision.
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