Wednesday, March 21, 2018

Perception bias in T1D communities: late onset type 1 diabetes

T1D communities are often very vocal when it comes to the issue of initial Type 1 Diabetes. This is especially true when a case of late diagnosis leading to a fatal or debilitating DKA goes viral. At that point, prayers and thoughts (which are as effective in preventing diabetes or treating DKA as they are in school shootings and gun control) fly and the T1D community erupts in “know the signs” memes and aggressive comments about medical professional who, at best, are accused of not doing what they should be doing, namely finger pricking every case of stomach flu they encounter. That measure that would be expensive, hard to interpret, lead to a lot of even more expensive confirmation tests. While they would probably yield a few earlier diagnosis, even fewer early stage DKA detections, the benefits – in the current state of therapies – would be nil in terms of long term prognosis and minimal in terms of DKA complications (ease of access to quality health care matters much more in terms of initial DKA prognosis, initial DKA isn’t a major factor in morbidity/mortality).

One of the latest circulating memes, recycling the “know the signs” memes, is that you can catch T1D at any age (true, although the onset is definitely skewed towards the young) and that T1D is often misdiagnosed as T2D. That’s understandable given the fact that T1D communities will have their fair share of members who have been diagnosed T1D after a misdiagnosis of T2D.

However, the T1D communities perception of “misdiagnosed” T1D is the result of multiple biases.

- Adult T2Ds far outnumber T1Ds.
- T2Ds who were initially misdiagnosed as T1Ds are unlikely to hang around in T1D communities.
- T1Ds who were initially misdiagnosed as T2Ds are likely to join T1D communities and likely to be unhappy and vocal about their misdiagnosis.

What’s the reality?

In fact, the issue is well known and well recognized

Late-onset type 1 diabetes is difficult to diagnose in people aged 31–60 years because it represents only a small minority of patients diagnosed with diabetes; its misdiagnosis as type 2 diabetes results in inappropriate treatment. (quote from the paper below)

However, given the huge discrepancy in the size of the respective populations, what actually happens in terms of diagnosis mistakes is the exact opposite of what the T1D communities are worried about.

Errors are often made when diagnosing type 1 diabetes later in life. For example, more than 50% of patients diagnosed with type 1 diabetes after age 35 years were shown to have type 2 diabetes in long-term follow-up. (quote from the paper below)

That issue is, for example, addressed in “Frequency and phenotype of type 1 diabetes in the first six decades of life: a cross-sectional, genetically stratified survival analysis from UK Biobank” (free full text).

One of the sensible ways to improve diagnosis accuracy as far as adult onset T1D and T2D is to take genetic predisposition factors into account.


  1. Just wanted to say a huge thank you to Dr Williams for everything he have done in my life. I have been in tears for so many years now, having found that my husband is suffering from diabetes, lesion after some years of being under extreme stress., . I spent 24 hours freaking out and finally calmed down after reading some testimony on here about Dr Williams herbal medicine to diabetes . The moment came and I mumbled out to my husband about Dr Williams product (with a few tears) and he was AMAZE – . He was just worried about his health, been free from this illness, that was how will order for Dr Williams product on line , after my husband finish taking Dr Williams medicine for just within a period of one month. Will went to the doc together who confirmed that he was diabetes free.
    Thank you again for being upfront, truthful and taking this pain away from my family for more information about his product you can email him on i hope you can also help other terrified people in a similar situation.

  2. I recently have some difficult conversations and I did what a lot of people do when they want to know how to do something. I googled it. I came across Dr Williams herbal medicine on YouTube so many people thanking him about his good work. I also have diabetes. I wasn’t running all over God’s creation with every man I could find but here I am. I have felt bad about myself for so many years now because of my diabetes status. I obviously still have some self-accepting to do but I want to thank Dr Williams for everything he have done for my family ,after taking Dr Williams medicine i was completely free from diabetes within one month of usage, I think what you are doing is so admirable. you have helped me a lot! I want to definitely reach out to you and thank you for your amazing work. You are a good person, and an extremely talented man. You have helped millions with your herbs, and have really inspired me,and i pray you still continue doing the good can also email him on for help