2026 Clinician Corner - Acute-onset autoimmune type 1 diabetes presenting with diabetic ketoacidosis in an obese adult

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Abstract 

Autoimmune type 1 diabetes mellitus (T1DM) has traditionally been associated with early onset disease and a lean phenotype; however, adult-onset disease increasingly presents with heterogeneous features that overlap with type 2 diabetes. We describe a 51-year-old obese man presenting with severe diabetic ketoacidosis (DKA). Laboratory evaluation demonstrated marked hyperglycemia (1297 mg/dL), metabolic acidosis (bicarbonate 7 mmol/L, anion gap 42), β-hydroxybutyrate >9 mmol/L, and hemoglobin A1c 13.3%. Autoimmune testing revealed strong glutamic acid decarboxylase antibody positivity with very low C-peptide, confirming profound insulin deficiency despite obesity. The patient improved with standard DKA management and was discharged on basal bolus insulin therapy. This case highlights the evolving phenotype of adult-onset autoimmune diabetes and emphasizes that obesity does not exclude T1DM. Early recognition using antibody testing and assessment of endogenous insulin secretion is essential to guide therapy and reduce recurrent metabolic decompensation. 

Keywords:  Adult-onset type 1 diabetes; autoimmune diabetes; diabetic ketoacidosis; obesity

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Faculty credentials/disclosure 

David Kweku Aseda Donkor, MD, Venkata Siva Dilisha Chandanala, MD, Akinfisoye Toluwalase, MD, Parth Adrejiya, MD, and Gichamo Adanech, MD 

Department of Internal Medicine, WellStar Spalding Regional Hospital, Griffin, Georgia, USA 

Corresponding author: David Kweku Aseda Donkor, MD, WellStar Spalding Regional Hospital, 601 S. 8th St., Griffin, GA 30224 (e-mail: [email protected]) 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

 

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on September 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Differentiate autoimmune type 1 diabetes from ketosis-prone diabetes and type 2 diabetes in adults presenting with diabetic ketoacidosis. 

  • Incorporate clinical considerations for long-term management of obese patients with autoimmune type 1 diabetes, including insulin therapy and weight management strategies. 

  • Apply islet autoantibody testing and C-peptide measurement appropriately in the classification of adult-onset diabetes, including recognition of limitations during acute metabolic decompensation. 

Key Points 

  • Autoimmune type 1 diabetes may present in obese adults with diabetic ketoacidosis; age and body habitus alone do not reliably distinguish diabetes subtype. 

  • In adults with new-onset diabetes and marked insulin deficiency, measurement of islet autoantibodies and C-peptide is essential to avoid misclassification and to guide timely initiation of insulin therapy. 

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Course summary

Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
09/01/2026
Course expires: 
09/01/2027
Cost:
$25.00

David Kweku Aseda Donkor, MD, Venkata Siva Dilisha Chandanala, MD, Akinfisoye Toluwalase, MD, Parth Adrejiya, MD, and Gichamo Adanech, MD 

Department of Internal Medicine, WellStar Spalding Regional Hospital, Griffin, Georgia, USA 

Corresponding author: David Kweku Aseda Donkor, MD, WellStar Spalding Regional Hospital, 601 S. 8th St., Griffin, GA 30224 (e-mail: [email protected]) 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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