From the Guidelines
Type 2 diabetics cannot become type 1 diabetics as they are fundamentally different conditions with distinct causes. Type 1 diabetes is an autoimmune disease where the body's immune system attacks and destroys insulin-producing beta cells in the pancreas, leading to little or no insulin production, as noted in the 2025 standards of care in diabetes 1. Type 2 diabetes, on the other hand, develops when the body becomes resistant to insulin or doesn't produce enough insulin to maintain normal blood glucose levels, which is discussed in the context of type 2 diabetes diagnosis and classification in 2025 1.
Key Differences and Considerations
- The diagnosis of type 1 versus type 2 diabetes can sometimes be challenging, and misdiagnosis is common, occurring in up to 40% of adults with new type 1 diabetes who may be misdiagnosed as having type 2 diabetes 1.
- Some type 2 diabetics may eventually require insulin therapy as their condition progresses, which can lead to confusion about their diagnosis, but this does not mean they have converted to type 1 diabetes.
- There are rare cases of people who have characteristics of both types, sometimes called "double diabetes" or "hybrid diabetes," but this is not a conversion from one type to another.
- The 2021 standards of medical care in diabetes also emphasize the importance of correct classification, noting that type 1 and type 2 diabetes are heterogeneous diseases with varying clinical presentations and disease progressions 1.
Clinical Implications
- The distinction between type 1 and type 2 diabetes is crucial for determining appropriate therapy and management strategies.
- Healthcare providers should be aware of the potential for misdiagnosis and consider the use of clinical tools like the AABBCC approach to distinguish between diabetes types, especially in adults where the diagnosis may not be straightforward 1.
- The focus should be on providing personalized care based on the individual's specific needs, regardless of the diabetes type, to improve outcomes and quality of life.
From the Research
Type 2 Diabetes and Autoimmune Diabetes
- Type 2 diabetics cannot directly become type 1 diabetics, as the underlying causes of the two conditions are different 2, 3.
- However, some individuals may be misclassified as having type 2 diabetes when they actually have latent autoimmune diabetes in adults (LADA), a form of autoimmune diabetes that typically develops in adults 2, 4.
- LADA is characterized by the presence of autoimmune antibodies, similar to those found in type 1 diabetes, and is often misdiagnosed as type 2 diabetes due to its later onset and slower progression 3, 5.
Latent Autoimmune Diabetes in Adults (LADA)
- LADA is a heterogeneous group of patients with clinical and genetic features intermediate between type 1 and type 2 diabetes 4, 6.
- The diagnosis of LADA is often made based on the presence of autoimmune antibodies, but this can be imperfect and may lead to misclassification of patients with non-autoimmune type 2 diabetes 4.
- Research suggests that LADA may represent a mixed population of autoimmune (type 1) and non-autoimmune (type 2) diabetes, rather than a distinct entity 4, 6.
Distinction between Type 1 and Type 2 Diabetes
- Type 1 diabetes is an autoimmune disease characterized by the destruction of pancreatic beta cells, while type 2 diabetes is a non-autoimmune disease characterized by insulin resistance and impaired insulin secretion 2, 3.
- The distinction between type 1 and type 2 diabetes is important for prognosis, treatment, and patient management, and misclassification can have significant consequences 2, 5.