In establishing these diagnostic criteria, we discussed whichis more suitable, between <3 months and <6 months as theperiod from the onset of hyperglycemic symptoms to initiationof insulin therapy, and concluded to use the former from aview point of the criteria of typical cases with acute-onset type1 diabetes. Furthermore, we made a criterion, ‘Need for continuousinsulin therapy after the diagnosis of diabetes mellitus’,because insulin-treated diabetic patients do not necessarily havetype 1 diabetes, and patients with ‘soft-drink ketosis’ haveacute-onset diabetes, but can withdraw insulin therapy afterseveral months. As anti-islet autoantibodies, which are the hallmarkof autoimmunity, can disappear after years of diabetesbeing present, it is important to prove endogenous insulin defi-ciency in patients with long-standing diabetes if they have noanti-islet autoantibodies. ‘Acute-onset type 1 diabetes mellitus’can be diagnosed when endogenous insulin deficiency isproved, even if anti-islet autoantibodies are negative, but reassessmentis required after a certain period in patients with preservedendogenous insulin secretion. Patients should not bediagnosed as having ‘acute-onset type 1 diabetes mellitus (idiopathic)’even if their GADA, IA-2A, IAA and ZnT8A are allnegative during the follow up, except for the case where thoseautoantibodies were measured at the onset of diabetes. This isbecause we cannot exclude the possibility that anti-islet autoantibodieswere positive soon after the development of type 1 diabetes.Tanaka et al.11 recently reported for the Committee onType 1 Diabetes, Japan Diabetes Society that the prevalence ofanti-islet autoantibody-negative type 1 diabetic patients with
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