Annals of Internal Medicine: Clinical Cases · Published 2026-07-01 · DOI 10.7326/aimcc.2025.1422
A 14-year-old boy with obesity (body mass index 30.5 kg/m²) presented with polyuria and polydipsia and severe hyperglycemia (hemoglobin A1C 15.5%). Islet autoimmunity was strongly positive (anti-glutamic acid decarboxylase 466 IU/mL; islet-cell antibody 61.8 U/mL), yet β-cell function was preserved (C-peptide 3.6 ng/mL) with insulin resistance (Homeostatic Model Assessment of Insulin Resistance score 4.6), acanthosis nigricans, and obesity. This discordant presentation challenged classification as type 1 or type 2 diabetes and supported a mixed/overlap (“double/hybrid”) phenotype. Basal insulin was administered in addition to pioglitazone/metformin in combination with close follow-up and cardiometabolic risk assessment.
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Zwain, Z. (2026). Mixed Diabetes (Type 1 and Type 2) in an Adolescent With Both Obesity/Insulin Resistance and Autoimmune Markers. Annals of Internal Medicine: Clinical Cases. https://doi.org/10.7326/aimcc.2025.1422