2. Diagnosis and classification of diabetes: standards of care in diabetes-2025

In the paper

“The rate of b-cell destruction is quite variable, being rapid in some individuals (particularly but not exclusively in infants and children) and slow in others (mainly but not exclusively adults) (44,58).”

What the sources say

• Partly supported

  The Introduction (page unavailable) reports that adults have a slower rate of C-peptide decline than children, and the Results find that age influences that rate. This supports the age-related pattern, but the paper measures C-peptide as an indicator of β-cell function, not the rate of β-cell destruction, and its participants were aged 3.9 years or older, so it does not establish the claim about infants. (LLM, conf=0.85)

  cites [44] Bogun, 2020, C-peptide levels in subjects followed longitudinally before and after type 1 diabetes diagnosis in TrialNet, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  The Results report variation in individual C-peptide decline, and the Discussion says decline was faster at ages 7–21 than above age 21. But the paper measures β-cell function after diagnosis, not destruction directly, and explicitly says its data cannot support conclusions about children younger than 7, including infants (Discussion; page unavailable). (LLM, conf=0.88)

  cites [58] Greenbaum, 2012, Fall in C-peptide during first 2 years from diagnosis: evidence of at least two distinct phases from composite type 1 diabetes TrialNet data, Diabetes sourceExperimental — accuracy not yet measured

In the paper

“Adults may retain sufficient b-cell function to prevent DKA for many years; such individuals may have remission characterized by decreased insulin needs for months or years, eventually become dependent on insulin for survival, and are at risk for DKA (33-35, 59,60).”

What the sources say

• ?Not checked — no full text of the sourcecites [33] Humphreys, 2019, Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12months following diagnosis of type 1 diabetes: an ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis, Diabetes Res Clin Pract source
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [34] Thomas, 2019, Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes, Diabetologia sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [35] Hope, 2016, Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis, Br J Gen Pract sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [59] Mishra, 2018, A global perspective of latent autoimmune diabetes in adults, Trends Endocrinol Metab source
• ?Not checked — no full text of the sourcecites [60] Buzzetti, 2017, Adult-onset autoimmune diabetes: current knowledge and implications for management, Nat Rev Endocrinol source

In the paper

“A1C may not be a suitable diagnostic test in people with anemia, people treated with erythropoietin, or people undergoing hemodialysis or HIV treatment (1,19,20).”

What the sources say

• Partly supported

  The 'Other Patient-Related Factors and Interfering Factors' section (page unavailable) says altered red-blood-cell turnover can make HbA1c results spurious and require glucose testing for diagnosis; it specifically discusses hemolytic and iron-deficiency anemia. The passages found do not address erythropoietin treatment, hemodialysis, or HIV treatment as reasons A1C may be unsuitable for diagnosis. (LLM, conf=0.86)

  cites [1] Sacks, 2023, Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  The Introduction (page not provided) notes that HbA1c screening may be unsuitable with abnormal red-cell turnover, including iron-deficiency anemia. The Discussion (page not provided) finds HbA1c insensitive for diagnosing diabetes in HIV-infected patients, though it also calls HbA1c a practical screening option when used with fasting blood glucose. Our copy does not address erythropoietin treatment or hemodialysis, and it does not establish the same concern for every form of anemia. (LLM, conf=0.87)

  cites [19] Eckhardt, 2012, Glycated hemoglobin A(1c) as screening for diabetes mellitus in HIV-infected individuals, AIDS Patient Care STDS sourceExperimental — accuracy not yet measured
• Supported

  The Conclusions report that A1C underestimates glycemia in HIV-infected patients, particularly in association with NRTI use, and suggest fructosamine may be more appropriate. This supports the cautious concern about A1C in people receiving HIV treatment; the other conditions in the multiply cited sentence are not attributed specifically to this paper. (LLM, conf=0.88)

  cites [20] Kim, 2009, A1C underestimates glycemia in HIV infection, Diabetes Care source

In the paper

“At stage 1, the 5-year risk of developing symptomatic type 1 diabetes is 44% overall but varies considerably based on number, titer, and specificity of autoantibodies as well as age of seroconversion and genetic risk (45).”

What the sources say

• Partly supported

  The Overview of Staging, Stage 1 section gives an approximately 44% five-year risk for children screened for genetic risk at birth who reach stage 1, not an overall estimate for everyone at stage 1. The Stage 1 section supports variation by autoantibody number, titer and type, age at seroconversion, and HLA genotype. (LLM, conf=0.84)

  cites [45] Insel, 2015, Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“At stage 2 of the disease, there is 60% risk by 2 years and 75% risk within 5 years of developing a clinical diagnosis of type 1 diabetes (55,56).”

What the sources say

• Partly supported

  The Results report that dysglycemia predicted progression to clinical type 1 diabetes, and that 75% of a small subgroup of children under 13 with persistent dysglycemia developed it during a maximum follow-up of 4.5 years. They do not report a 60% risk by two years or a 75% five-year risk for everyone at stage 2; the reported five-year estimate for children under 13 with dysglycemia was 94%. Page numbers were not available in our copy. (LLM, conf=0.86)

  cites [55] Sosenko, 2009, Incident dysglycemia and progression to type 1 diabetes among participants in the Diabetes Prevention Trial-Type 1, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  The Results report a 74% risk of type 1 diabetes four years after confirmed dysglycaemia, close to the claimed 75% but at a different time point. They do not report a 60% risk of clinical diagnosis at two years; the two-year figure for this group is a 41% risk of progressing from normal glucose tolerance to dysglycaemia. No page number is available in our copy. (LLM, conf=0.83)

  cites [56] Krischer, 2013, The use of intermediate endpoints in the design of type 1 diabetes prevention trials, Diabetologia sourceExperimental — accuracy not yet measured

In the paper

“The features most useful in determination of type 1 diabetes include younger age at diagnosis (<35 years) with lower BMI (<25 kg/m 2 ), unintentional weight loss, ketoacidosis, and plasma glucose >360 mg/dL (>20 mmol/L) at presentation (36) (Fig.”

What the sources say

• Supported

  The ‘Differentiating Type 1 Diabetes From Type 2 Diabetes’ section identifies age under 35 as the most discriminative feature and lists lower BMI, unintentional weight loss, ketoacidosis, and glucose above 20 mmol/L (360 mg/dL) at presentation as informative. The claim accurately paraphrases that list; the source also cautions that no single feature confirms the diagnosis. (LLM, conf=0.95)

  cites [36] Holt, 2021, The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care source

In the paper

“and that misdiagnosis is common and can occur in 40% of adults with new type 1 diabetes (e.g., adults with type 1 diabetes misdiagnosed as having type 2 diabetes).”

What the sources say

• Partly supported

  The “Differentiating Type 1 Diabetes From Type 2 Diabetes” section says misclassification is common and that over 40% of people developing type 1 diabetes after age 30 are initially treated as having type 2 diabetes. The claim omits the age-after-30 qualifier, presenting the figure as applying to adults with new type 1 diabetes generally. (LLM, conf=0.87)

  cites [36] Holt, 2021, The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“FPG, 2-h PG, and A1C reflect different aspects of glucose metabolism, and diagnostic cut points for the different tests will identify groups with incomplete concordance (3).”

What the sources say

• Supported

  The Limitations of A1C section says A1C and glucose measurements reflect different aspects of glucose metabolism and may identify different individuals. The Practical Issues section explicitly says A1C, FPG, and 2HPG are not completely concordant. Page numbers were not supplied in our copy. (LLM, conf=0.94)

  cites [3] International Expert Committee, 2009, International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes, Diabetes Care source

In the paper

“Occasionally, people with type 2 diabetes may present with DKA (37), particularly members of certain racial, ethnic, and ancestral groups (e.g., African American and Hispanic/Latino adults), who may present with ketosisprone type 2 diabetes (30).”

What the sources say

• ?Not checked — no full text of the sourcecites [37] Zhong, 2018, Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998-2013: a retrospective cohort study, Diabetes Care source
• Supported

  The citation to this source is attached to the first clause: that people with type 2 diabetes may present with DKA. Section 1 reports DKA presentations among people found to have type 2 diabetes and notes that most DKA events occur in people with type 1 diabetes. The later claim about specific groups has a different citation. (LLM, conf=0.91)

  cites [30] Umpierrez, 2024, Hyperglycemic crises in adults with diabetes: a consensus report, Diabetes Care source

In the paper

“Diagnostic accuracy may be improved by using higher-specificity tests, using confirmatory testing for other autoantibodies, and restricting testing to those with clinical features suggestive of autoimmune diabetes (48).”

What the sources say

• Supported

  The “Implications for Researchers” section recommends increasing assay specificity in low-risk populations, requiring multiple positive autoantibodies, or using clinical features to increase the prior probability of autoimmune diabetes. “Practical Implications for Clinicians” likewise says antibody testing has greater diagnostic utility when there is clinical suspicion of type 1 diabetes. (LLM, conf=0.93)

  cites [48] Jones, 2021, Latent autoimmune diabetes of adults (LADA) is likely to represent a mixed population of autoimmune (type 1) and nonautoimmune (type 2) diabetes, Diabetes Care source

In the paper

“Of the 585 children who developed more than two autoantibodies, nearly 70% developed type 1 diabetes within 10 years and 84% within 15 years (40).”

What the sources say

• Partly supported

  The Results section (“Children With Multiple Islet Autoantibodies”; page not provided) reports 585 children and estimated diabetes progression of 69.7% at 10 years and 84.2% at 15 years after seroconversion. But “multiple” includes children with two autoantibodies, whereas the claim says more than two. The reported percentages are follow-up risk estimates, not counts of children who developed diabetes. (LLM, conf=0.90)

  cites [40] Ziegler, 2013, Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children, JAMA sourceExperimental — accuracy not yet measured

In the paper

“This immune-related adverse event occurs in just under 1% of checkpoint inhibitortreated individuals but most commonly occurs with agents that block the programmed cell death protein 1/programmed cell death ligand 1 pathway alone or in combination with other checkpoint inhibitors (66).”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [66] Stamatouli, 2018, Collateral damage: insulin-dependent diabetes induced with checkpoint inhibitors, Diabetes source

In the paper

“Such testing, coupled with education about diabetes symptoms and close follow-up, has been shown to enable earlier diagnosis and to prevent DKA (77,78).”

What the sources say

• Supported

  The study’s follow-up description (page unavailable) says families of autoantibody-positive children were taught symptoms of hyperglycemia and their children received regular testing. The discussion reports earlier detection and decreased hospitalization for DKA at onset among screened, closely followed high-risk children; the onset-hospitalization results show 3.3% hospitalized versus 44% of community cases. This supports prevention in the sense of reducing DKA risk, not guaranteeing that no child develops DKA. (LLM, conf=0.88)

  cites [77] Barker, 2004, Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up, Diabetes Care source
• Partly supported

  The Discussion says that monitoring with screening and repeated education about symptoms may improve outcomes, and that TEDDY children had low DKA rates compared with the general population. It also links close follow-up to early diagnosis. But the Results report DKA in 8 of 100 children, so the paper supports a lower DKA rate, not a categorical claim that follow-up prevents DKA. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  cites [78] Elding Larsson, 2014, Children followed in the TEDDY study are diagnosed with type 1 diabetes at an early stage of disease, Pediatr Diabetes sourceExperimental — accuracy not yet measured

In the paper

“As many genetic risk studies have been performed in populations of European ancestry and discriminatory ability may differ in those of different ancestry, more large case-control cohorts from non-European populations are still needed (82).”

What the sources say

• Supported

  In “Differences in trans-ancestry and ancestry-specific scores” (page not provided), the paper states that the GRS models were derived from European-ancestry cohorts and that their discriminatory power may differ in other ancestries. “Availability and barriers to translation” (page not provided) identifies limited use in non-European cohorts as a major limitation, consistent with the call for more such cohorts. (LLM, conf=0.91)

  cites [82] Luckett, 2023, Utility of genetic risk scores in type 1 diabetes, Diabetologia source

In the paper

“However, ADA clinical guidance concluded that A1C, FPG, or 2-h PG also could be used to test for prediabetes or type 2 diabetes in children and adolescents (114).”

What the sources say

• Supported

  In “Risk Assessment and Diagnostic Criteria,” the ADA position statement explicitly recommends fasting plasma glucose, 2-hour plasma glucose after an OGTT, or A1C to test for prediabetes or diabetes. The recommendation appears in the context of risk-based screening for children and adolescents. (LLM, conf=0.95)

  cites [114] Arslanian, 2018, Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association, Diabetes Care source

In the paper

“The ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in people of reproductive age, with an increase in the number of pregnant individuals with undiagnosed type 2 diabetes in early pregnancy (164-166).”

What the sources say

• ?Not checked — no full text of the sourcecites [164] Feig, 2014, Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996-2010, Diabetes Care source
• Partly supported

  The Comments report increasing pregestational type 2 diabetes and suggest that rising obesity among women of reproductive age likely contributed. But Materials and Methods says the study identified diabetes clinically recognized before pregnancy; it does not establish an increase in undiagnosed type 2 diabetes in early pregnancy. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  cites [165] Peng, 2017, Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014, Am J Obstet Gynecol sourceExperimental — accuracy not yet measured
• Partly supported

  The Introduction and Results report increasing type 2 diabetes among women of child-bearing age and pregnant women. The Introduction gives an estimate of undiagnosed diabetes only for US adults generally; it does not establish an increase among pregnant people in early pregnancy. The paper also does not attribute the increase to obesity. (LLM, conf=0.88)

  cites [166] Jovanovič, 2015, Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy, Diabetes Metab Res Rev sourceExperimental — accuracy not yet measured

In the paper

“Although the use of immunosuppressive therapies is a major contributor to the development of PTDM, the risks of transplant rejection outweigh the risks of PTDM, and the role of the diabetes health care professional is to treat hyperglycemia appropriately regardless of the type of immunosuppression (138).”

What the sources say

• Partly supported

  Recommendation 5 (page not provided) identifies immunosuppression as the major modifiable risk factor for PTDM and advises choosing regimens for patient and graft survival rather than PTDM risk alone. It calls for balancing PTDM against rejection risk, however, rather than saying rejection risk always outweighs PTDM risk. Recommendation 6 recommends treating posttransplant hyperglycemia, but does not specifically assign that role to diabetes health care professionals regardless of immunosuppression type. (LLM, conf=0.87)

  cites [138] Sharif, 2014, Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions, Am J Transplant sourceExperimental — accuracy not yet measured

In the paper

“Cystic fibrosis-related diabetes (CFRD) is a common comorbidity in people with cystic fibrosis, occurring in about 20% of adolescents and 40-50% of adults (127).”

What the sources say

• Supported

  The Incidence and Prevalence section reports CFRD in 15%–20% of adolescents, 40% of people aged 20–39, and more than 50% of those over 40 in the University of Minnesota data. These figures support the citing sentence’s approximate description, though prevalence varies by adult age group and dataset. (LLM, conf=0.87)

  cites [127] Ode, 2022, ISPAD Clinical Practice Consensus Guidelines 2022: management of cystic fibrosis-related diabetes in children and adolescents, Pediatr Diabetes source

In the paper

“A1C is not recommended for screening due to low sensitivity; however, a value of $6.5% ($48 mmol/mol) is consistent with a diagnosis of CFRD and reduces patient screening burden (129-131).”

What the sources say

• ?Not checked — no full text of the sourcecites [129] Gilmour, 2019, Response to the letter to the editor from Dr. Boudreau et al, “Validation of a stepwise approach using glycated hemoglobin levels to reduce the number of required oral glucose tolerance tests to screen for cystic fibrosis-related diabetes in adults, Can J Diabetes source
• ?Not checked — no full text of the sourcecites [130] Gilmour, 2019, Cystic fibrosis-related diabetes screening in adults: a gap analysis and evaluation of accuracy of glycated hemoglobin levels, Can J Diabetes source
• Partly supported

  The Discussion says HbA1c has low sensitivity for diagnosing CFRD and that guidelines do not recommend it for screening. Our copy does not state that an HbA1c value of ≥6.5% diagnoses CFRD; its Introduction presents reduced screening burden only as a potential benefit if HbA1c proved suitable, while its Conclusion does not support its use for screening pre-CFRD dysglycemia. Page numbers are not available in our copy. (LLM, conf=0.88)

  cites [131] Darukhanavala, 2021, Use of hemoglobin A1c to identify dysglycemia in cystic fibrosis, PLoS One sourceExperimental — accuracy not yet measured

In the paper

“It is inherited in an autosomal dominant pattern with abnormalities in at least 14 genes on different chromosomes identified to date (152).”

What the sources say

• Partly supported

  The section on autosomal dominant familial mild hyperglycemia or diabetes (MODY; page unavailable) says known MODY subtypes involve dominantly acting mutations and that at least 14 genes have been reported to cause a MODY-like phenotype. It does not establish that those genes are all on different chromosomes, and it qualifies the count as genes reported to cause a MODY-like phenotype. (LLM, conf=0.82)

  cites [152] Greeley, 2022, ISPAD Clinical Practice Consensus Guidelines 2022: the diagnosis and management of monogenic diabetes in children and adolescents, Pediatr Diabetes sourceExperimental — accuracy not yet measured

In the paper

“The Cystic Fibrosis Foundation Patient Registry (132) evaluated 3,553 people with cystic fibrosis and identified 445 (13%) with CFRD.”

What the sources say

• Supported

  The Abstract states that the study used the CF Foundation Patient Registry and that 445 (13%) of 3,553 patients were diagnosed with CFRD. The Results section repeats both counts; the cohort consisted of patients with CF who turned 10 during the study period. (LLM, conf=0.94)

  cites [132] Franck Thompson, 2020, The association of pediatric cystic fibrosis-related diabetes screening on clinical outcomes by center: a CF patient registry study, J Cyst Fibros source

In the paper

“Whereas posttransplantation hyperglycemia is an important risk factor for subsequent PTDM, a formal diagnosis of PTDM is optimally made once the individual is stable on maintenance immunosuppression (usually at least 45 days) and in the absence of acute infection (138,(142)(143)(144)147).”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [138] Sharif, 2014, Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions, Am J Transplant sourceExperimental — accuracy not yet measured
• ?Could not verify

  Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

  cites [142] Thomas, 2000, Early peri-operative hyperglycaemia and renal allograft rejection in patients without diabetes, BMC Nephrol sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [143] Chakkera, 2009, Hyperglycemia during the immediate period after kidney transplantation, Clin J Am Soc Nephrol sourceExperimental — accuracy not yet measured

In the paper

“As the A1C test may underestimate glycemia in people with HIV, plasma glucose criteria are preferred to diagnose prediabetes and diabetes (20).”

What the sources say

• Partly supported

  The Abstract Results and Conclusions report that A1C underestimated glycemia in the HIV-infected patients studied. The paper does not recommend plasma glucose criteria over A1C for diagnosing prediabetes or diabetes; its Conclusions instead suggest that fructosamine may be more appropriate for assessing glycemia in this setting. (LLM, conf=0.88)

  cites [20] Kim, 2009, A1C underestimates glycemia in HIV infection, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“Correct diagnosis of monogenic forms of diabetes is critical because people who have them may be incorrectly diagnosed with type 1 or type 2 diabetes, leading to suboptimal, even potentially harmful, treatment plans and delays in diagnosing other family members (152).”

What the sources say

• Supported

  The MODY section says that children with genetically proven monogenic diabetes are often initially misdiagnosed as having type 1 or type 2 diabetes. The Clinical Relevance section says a molecular diagnosis guides appropriate treatment and frequently prompts testing of affected family members. Together with the Executive Summary’s warning that some patients should not receive treatment, these passages support the claim’s qualified description of treatment risks and missed opportunities for family diagnosis. (LLM, conf=0.87)

  cites [152] Greeley, 2022, ISPAD Clinical Practice Consensus Guidelines 2022: the diagnosis and management of monogenic diabetes in children and adolescents, Pediatr Diabetes source

In the paper

“The preconception care of people with known preexisting diabetes results in lower A1C and reduced risk of birth defects, preterm delivery, perinatal mortality, small-for-gestational-age birth weight, and neonatal intensive care unit admission (173).”

What the sources say

• Partly supported

  The Conclusion (page not provided) reports lower HbA1c and reduced congenital malformations, perinatal mortality, and small-for-gestational-age births in women with pregestational diabetes. It says preconception care *may* reduce preterm delivery and NICU admission; the claim presents those two effects as unqualified results. (LLM, conf=0.87)

  cites [173] Wahabi, 2020, Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes, PLoS One sourceExperimental — accuracy not yet measured

In the paper

“Community screening may also be poorly targeted; i.e., it may fail to reach the groups most at risk and inappropriately test those at very low risk or even those who have already been diagnosed (110).”

What the sources say

• Supported

  The Results report that 90% of those screened were white and 91% had access to primary care, while the paper recommends better targeting of racial and ethnic minority groups and medically underserved people. The Results also report that 14% were screened contrary to guidelines, including 11% who already had diagnosed diabetes. The paper notes that many participants were nevertheless at high risk by age or questionnaire score, consistent with the claim's qualified wording. (LLM, conf=0.91)

  cites [110] Tabaei, 2003, Community-based screening for diabetes in Michigan, Diabetes Care source

In the paper

“Genetic screening (i.e., next-generation sequencing) is increasingly available and cost-effective (152).”

What the sources say

• Partly supported

  In ‘Selecting candidates for molecular testing,’ the guidelines say genetic testing is available in many countries and that NGS has a lower cost per gene. They also say NGS panels remain expensive and that cost-effectiveness depends on the condition and selection of patients; the claim presents cost-effectiveness without those qualifications. (LLM, conf=0.87)

  cites [152] Greeley, 2022, ISPAD Clinical Practice Consensus Guidelines 2022: the diagnosis and management of monogenic diabetes in children and adolescents, Pediatr Diabetes sourceExperimental — accuracy not yet measured

In the paper

“Early abnormal glucose metabolism, defined as a fasting glucose threshold of 110 mg/dL (6.1 mmol/L) or an A1C of 5.9% (41 mmol/mol), may identify individuals who are at higher risk of adverse pregnancy and neonatal outcomes (preeclampsia, macrosomia, shoulder dystocia, and perinatal death), are at high risk of a later GDM diagnosis, and are more likely to need insulin treatment (174-176).”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [174] Zhu, 2013, Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [175] Mañé, 2019, Association of first-trimester HbA1c levels with adverse pregnancy outcomes in different ethnic groups, Diabetes Res Clin Pract sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [176] Kattini, 2020, Early gestational diabetes mellitus screening with glycated hemoglobin: a systematic review, J Obstet Gynaecol Can source

In the paper

“The OGTT glucose cutoffs in these two trials overlapped the thresholds recommended by the IADPSG, and in one trial (195), the 2-h PG threshold (140 mg/dL [7.8 mmol/L]) was lower than the cutoff recommended by the IADPSG (153 mg/dL [8.5 mmol/L]).”

What the sources say

• Supported

  The Design and Study Population section states that this trial used a 75-g OGTT with a two-hour eligibility threshold beginning at 7.8 mmol/L (140 mg/dL). That supports the trial-specific cutoff attributed to this source; the comparison with the IADPSG cutoff is made by the citing authors. (LLM, conf=0.91)

  cites [195] Crowther, 2005, Effect of treatment of gestational diabetes mellitus on pregnancy outcomes, N Engl J Med source

In the paper

“A systematic review of economic evaluations of GDM screening found that the one-step method identified more cases of GDM and was more likely to be cost-effective than the two-step method (211).”

What the sources say

• Supported

  The review’s Conclusions state that one-step screening detects more cases and is more likely to be cost-effective than two-step screening. The Abstract Results make the same comparison; the Results section notes that cost-effectiveness varied with assumptions, which is consistent with the claim’s qualified wording. (LLM, conf=0.95)

  cites [211] Mo, 2021, Economic evaluations of gestational diabetes mellitus screening: a systematic review, J Epidemiol source

In the paper

“The GDM diagnostic criteria for the 75-g OGTT from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and the GDM screening and diagnostic criteria with the two-step approach were not derived from data in the first half of pregnancy”

What the sources say

• Partly supported

  In the main text (pp. 53–54), the paper contrasts standard GDM testing at 24–32 weeks with early pregnancy and says evidence is insufficient to recommend early-pregnancy OGTT cutoffs. This supports the point about applying IADPSG criteria in the first half of pregnancy, but the paper does not discuss the derivation of screening or diagnostic criteria for the two-step approach. (LLM, conf=0.88)

  cites [179] McIntyre, 2016, Issues with the diagnosis and classification of hyperglycemia in early pregnancy, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“Post hoc GDM in individuals diagnosed with this method in the HAPO cohort was associated with higher prevalence of IGT; higher 30-min, 1-h, and 2-h glucose levels during the OGTT; and reduced insulin sensitivity and oral disposition index in their offspring at 10-14 years of age compared with offspring of mothers without GDM.”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [198] Lowe, 2019, Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism, Diabetes Care source
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [199] Scholtens, 2019, Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal glycemia and childhood glucose metabolism, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“This one-step strategy was anticipated to significantly increase the incidence of GDM (from 5-6% to 15-20%), primarily because only one abnormal value, not two, became sufficient to make the diagnosis (191).”

What the sources say

• Partly supported

  The HAPO Study summary (p. 1) says the IADPSG criteria require one or more glucose values at or above threshold and reports a GDM frequency of 17.8%, within the claimed 15–20% range. It does not give a previous rate of 5–6%, describe the increase as anticipated, or establish that the change from two abnormal values to one was its primary cause. (LLM, conf=0.87)

  cites [191] Sacks, 2012, Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“GDM is often indicative of underlying b-cell dysfunction (182), which confers marked increased risk for later development of glucose intolerance and diabetes in the mother after delivery (183-185).”

What the sources say

• ?Not checked — no full text of the sourcecites [182] Buchanan, 2007, What is gestational diabetes?, Diabetes Care source
• ?Not checked — no full text of the sourcecites [183] Noctor, 2016, Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria, Eur J Endocrinol source
• Supported

  This source is cited for the later-risk clause (183–185); the beta-cell dysfunction clause has a separate citation (182). The Introduction identifies GDM as a maternal risk factor for type 2 diabetes, and the Conclusions report that progression rises steeply in the first five years after delivery. The review does not establish beta-cell dysfunction as the cause of that risk. (LLM, conf=0.90)

  cites [184] Kim, 2002, Gestational diabetes and the incidence of type 2 diabetes: a systematic review, Diabetes Care source
• ?Not checked — no full text of the sourcecites [185] Liu, 2023, Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis, Endocrine source

In the paper

“Treatment of higherthreshold maternal hyperglycemia, as identified by the two-step approach, reduces rates of neonatal macrosomia, large-forgestational-age births (207), and shoulder dystocia without increasing small-forgestational-age births.”

What the sources say

• Partly supported

  The Results (Packages of care and dietary modification trials; page unavailable) report reduced macrosomia, large-for-gestational-age births, and shoulder dystocia with treatment compared with routine care. The Discussion says the largest trials used criteria associated with more severe hyperglycaemia, but the review does not limit its pooled finding to women identified by a two-step approach. Its reported outcomes do not establish that treatment leaves small-for-gestational-age births unchanged. (LLM, conf=0.88)

  cites [207] Farrar, 2017, Treatments for gestational diabetes: a systematic review and meta-analysis, BMJ Open sourceExperimental — accuracy not yet measured

In the paper

“A1C is an indirect measure of glucose exposure, and factors that affect hemoglobin concentrations or erythrocyte turnover can affect A1C (e.g., thalassemia or folate deficiency) (Table 2.3).”

In the paper

“Children and adolescents often present with DKA as the first manifestation of the disease, and rates in the U.S. have increased over the past 20 years (30)(31)(32).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (30)(31)(32)

In the paper

“In at-risk cohorts followed from birth or a very young age, seroconversion rarely occurs before 6 months of age and there is a peak in seroconversion between 9 and 24 months of age (41)(42)(43).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (41)(42)(43)

In the paper

“Children with type 1 diabetes often present with the hallmark symptoms of polyuria/polydipsia, and approximately half present with DKA (30)(31)(32).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (30)(31)(32)

In the paper

“The onset of type 1 diabetes may be more variable in adults; they may not present with the classic symptoms seen in children and may progress to insulin replacement more slowly (33)(34)(35).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (33)(34)(35)

In the paper

“Prediabetes and type 2 diabetes meet criteria for conditions in which early detection via screening is appropriate.”

In the paper

“Fulminant onset of type 1 diabetes can occur, with DKA and low or undetectable levels of C-peptide as a marker of endogenous b-cell function (63)(64)(65).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (63)(64)(65)

In the paper

“Remarkably, the findings in all three groups were the same, suggesting that the same sequence of events led to clinical disease in both “sporadic” and familial cases of type 1”

In the paper

“People with type 1 diabetes often present with acute symptoms of diabetes and markedly elevated blood glucose levels, and 25-50% are diagnosed with life-threatening DKA (30)(31)(32).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (30)(31)(32)

In the paper

“The incidence and prevalence of type 1 diabetes are increasing (70).”

What the sources say

• ?Not checked — no full text of the sourcecites [70] Gregory, 2022, Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study, Lancet Diabetes Endocrinol source

In the paper

“The risk of developing type 2 diabetes increases with age, obesity, and lack of physical activity (95,96).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [95] U.S. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Estimates of Diabetes and Its Burden in the United States. Accessed 11 September 2024. Available from https://www.cdc.gov/diabetes/php/data-research/index.html
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [96] International Diabetes Federation . IDF Diabetes Atlas, 10th edition. Brussels, Belgium, International Diabetes Federation,2021. Accessed 5 August 2024. Available from https://www.diabetesatlas.org/atlas/tenth-edition/

In the paper

“During the coronavirus disease 2019 (COVID-19) pandemic, numbers of cases of hyperglycemia, DKA, and new diabetes increased, suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a trigger for or can unmask type 1 diabetes (68).”

What the sources say

• ?Not checked — no full text of the sourcecites [68] Wang, 2023, COVID-19 as a trigger for type 1 diabetes, J Clin Endocrinol Metab source

In the paper

“A diagnosis of one of the three most common forms of MODY, HNF1A-MODY, GCK-MODY, and HNF4A-MODY, allows for more cost-effective personalized therapy (i.e., no therapy for GCK-MODY and sulfonylureas as first-line therapy for HNF1A-MODY and HNF4A-MODY).”

In the paper

“The rationale for the 3-year interval is that with this interval, the number of false-positive tests that require confirmatory testing will be reduced, and individuals with false-negative tests will be retested before substantial time elapses and complications develop (109).”

What the sources say

• ?Not checked — no full text of the sourcecites [109] Johnson, 2005, The efficacy and cost of alternative strategies for systematic screening for type 2 diabetes in the U.S. population 45-74 years of age, Diabetes Care source

In the paper

“Not unexpectedly, annual OGTTs are perceived as burdensome, and engagement in current CFRD screening guidelines is poor, with only 30% of adults with cystic fibrosis having annual OGTTs (128).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [128] Cystic Fibrosis Foundation . Patient Registry 2022 Annual Data Report. Bethesda, MD, Cystic Fibrosis Foundation, 2022. Accessed 5 August 2024. Available from https://www.cff.org/media/31216/download

In the paper

“New-onset diabetes is estimated to occur in more than 5% of individuals infected with HIV on PIs, whereas more than 15% may have prediabetes (107).”

What the sources say

• ?Not checked — no full text of the sourcecites [107] Monroe, 2015, Diagnosing and managing diabetes in HIV-infected patients: current concepts, Clin Infect Dis source

In the paper

“First, the best evidence reveals that many cases of GDM represent preexisting hyperglycemia that is detected by routine screening in pregnancy, as routine screening is not widely performed in nonpregnant individuals of reproductive age.”

In the paper

“The European Cystic Fibrosis Society Patient Registry reported an increase in CFRD with age (10% increase per decade), genotype, decreased lung function, and female sex (133).”

What the sources say

• ?Not checked — no full text of the sourcecites [133] Olesen, 2020, Cystic fibrosis related diabetes in Europe: prevalence, risk factors and outcome, J Cyst Fibros source

In the paper

“Additionally, diagnosis can lead to identification of other affected family members and can indicate potential extrapancreatic complications in affected individuals.”

In the paper

“There was also a suggestion of more benefit (per prespecified subgroup analyses) among individuals who had the OGTT at <14 weeks and among those with OGTT glycemic values in higher ranges (180).”

What the sources say

• ?Not checked — no full text of the sourcecites [180] Simmons, 2023, Treatment of gestational diabetes mellitus diagnosed early in pregnancy, N Engl J Med source

In the paper

“A1C is not reliable for screening for GDM or for preexisting diabetes at 15 weeks of gestation or later in part from the higher red blood cell turnover in pregnancy but also from the unknown diabetes status prior to pregnancy, which could help distinguish new-onset diabetes from preexisting diabetes.”

What the sources say

• ?Not checked — no full text of the sourcecites [181] Cavagnolli, 2015, Factors affecting A1C in non-diabetic individuals: review and meta-analysis, Clin Chim Acta source

In the paper

“The one-step method identifies longterm risks of maternal prediabetes and diabetes as well as offspring glucose intolerance and adiposity.”

In the paper

“If this approach is implemented, the incidence of GDM will likely increase markedly.”

In the paper

“A 2021 U.S. Preventive Services Task Force systematic review concluded that onestep versus two-step screening is associated with increased likelihood of GDM (11.5% vs. 4.9%) but without improved health outcomes (205).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [205] Pillay, 2021