Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
June 7, 2026Diabetes

AABBCC criteria fail to identify ~75% of patients reclassified to T1D.

View Full Paper
Ask AI
Bookmark
Share

Why the study?

The American Diabetes Association proposed the AABBCC approach to help distinguish diabetes types, but reclassification rates and real-world applicability of the criteria needed evaluation.

Population

6,759,145 individuals in the US with prediabetes or T2D

Design

Retrospective electronic health records cohort study

Key result

The AABBCC criteria failed to identify approximately 75% of patients reclassified to T1D, with only 1.6% of reclassified cases meeting both age <35 years and BMI <25 kg/m2 criteria.

Authors

JSJay ShubrookCSCYNTIA B. MANZANO SALGADOMBMireille Bonnemaire

Discussion

Loading...

Member takes

Overview

AABBCC criteria miss most reclassified T1D cases in real-world EHR data; hypothesis-generating for refined adult diabetes classification tools.

Key Points

  • This study aims to assess the effectiveness of the AABBCC criteria in reclassifying diabetes types among patients.
  • Identified individuals in the US with prediabetes or type 2 diabetes diagnoses using TriNetX electronic health records.
  • Analyzed data availability for age, BMI, comorbidities, and HbA1c to evaluate AABBCC criteria applicability.
  • Followed up individuals from diagnosis of prediabetes or T2D until diagnosis of T1D, end of study, death, or loss to follow-up.
  • 2.2% of individuals with prediabetes or T2D were reclassified as T1D.
  • Among individuals <35 years old, 5.1% were reclassified, constituting 23.6% of all reclassified cases.
  • Approximately 75% of individuals could not be identified using AABBCC criteria, revealing significant limitations.

Study Design

Type

Cohort (n=6,759,145)

Multicenter

Yes

Structured PICO

P
Population
6,759,145 individuals in the US with prediabetes or type 2 diabetes, evaluated for reclassification to type 1 diabetes using electronic health records.
E
Exposure
Application of the AABBCC criteria (Age <35 years, Autoimmunity, BMI <25 kg/m2, Background, Control, and Comorbidities) for diabetes classification
O
Outcome
Reclassification rates from prediabetes or type 2 diabetes to type 1 diabetes

The AABBCC criteria proposed by the ADA are insufficient to accurately identify adult patients with type 1 diabetes among those initially diagnosed with prediabetes or type 2 diabetes in real-world settings.

Limitations

  • Data availability for AABBCC criteria was limited in electronic health records (e.g., BMI 35.8%, comorbidities 9.7%, HbA1c 6.1%).
  • Overlap in clinical features makes differentiating T1D from T2D challenging.
  • Limited data availability for AABBCC criteria components in electronic health records (e.g., BMI 35.8%, comorbidities 9.7%, HbA1c 6.1%, autoimmune comorbidities 5.1%)

Cite This Study

Shubrook et al. (2026) conducted a cohort in Prediabetes or Type 2 Diabetes (n=6,759,145). AABBCC criteria was evaluated on Reclassification to type 1 diabetes. The AABBCC criteria failed to identify approximately 75% of patients reclassified to T1D, with only 1.6% of reclassified cases meeting both age <35 years and BMI <25 kg/m2 criteria.

synapsesocial.com/papers/6a250cbc7def13d035e1cdd6https://doi.org/10.2337/db26-2231-p
View Full Paper
Ask AI
Bookmark
Share