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Kawasaki E, Awata T, Ikegami H, Imagawa A, Oikawa Y, Osawa H, Katsuki T, Kanatsuna N, Kawamura R, Kozawa J, Kodani N, Kobayashi T, Shimada A, Shimoda M, Takahashi K, Chujo D, Tsujimoto T, Tsuchiya K, Terakawa A, Terasaki J, Nagasawa K, Noso S, Fukui T, Horie I, Yasuda K, Yasuda H, Yanai H, Hanafusa T, Kajio H. Prediction of future insulin-deficiency in glutamic acid decarboxylase autoantibody enzyme-linked immunosorbent assay-positive patients with slowly-progressive type 1 diabetes. J Diabetes Investig 2024; 15:835-842. [PMID: 38451108 PMCID: PMC11215668 DOI: 10.1111/jdi.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS/INTRODUCTION This study aimed to identify risk factors that contribute to the progression of slowly-progressive type 1 diabetes by evaluating the positive predictive value (PPV) of factors associated with the progression to an insulin-dependent state. MATERIALS AND METHODS We selected 60 slowly-progressive type 1 diabetes patients who tested positive for glutamic acid decarboxylase autoantibodies (GADA) at diagnosis from the Japanese Type 1 Diabetes Database Study. GADA levels in these patients were concurrently measured using both radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) techniques. RESULTS Compared with the non-progressor group (fasting C-peptide [F-CPR] levels maintained ≥0.6 ng/mL), the progressor group showed a younger age at diagnosis, lower body mass index (BMI), lower F-CPR levels and a higher prevalence of insulinoma-associated antigen-2 autoantibodies (IA-2A). The PPV of RIA-GADA increased from 56.3 to 70.0% in the high titer group (≥10 U/mL), and further increased to 76.9, 84.2, 81.0 and 75.0% when combined with specific thresholds for age at diagnosis <47 years, BMI <22.6 kg/m2, F-CPR <1.41 ng/mL and IA-2A positivity, respectively. In contrast, the PPV of ELISA-GADA (71.8%) remained the same at 73.1% in the high titer group (≥180 U/mL), but increased to 81.8, 82.4 and 79.0% when evaluated in conjunction with age at diagnosis, BMI and F-CPR level, respectively. CONCLUSIONS Our findings show that, unlike RIA-GADA, ELISA-GADA shows no association between GADA titers and the risk of progression to an insulin-dependent state. The PPV improves when age at diagnosis, BMI and F-CPR levels are considered in combination.
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Affiliation(s)
| | - Takuya Awata
- Pancreatic Islet Cell Transplantation CenterNational Center for Global Health and MedicineTokyoJapan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | - Akihisa Imagawa
- Department of Internal Medicine (I)Osaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversityIrumaJapan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Takeshi Katsuki
- Department of Diabetes and EndocrinologyTokyo Saiseikai Central HospitalTokyoJapan
| | - Norio Kanatsuna
- Department of Internal Medicine (I)Osaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Ryoichi Kawamura
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of MedicineOsaka UniversitySuitaJapan
| | - Noriko Kodani
- Department of Diabetes, Endocrinology, and MetabolismCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
| | | | - Akira Shimada
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversityIrumaJapan
| | - Masayuki Shimoda
- Pancreatic Islet Cell Transplantation CenterNational Center for Global Health and MedicineTokyoJapan
| | | | - Daisuke Chujo
- Center for Clinical ResearchToyama University HospitalToyamaJapan
| | - Tetsuro Tsujimoto
- Department of Diabetes and EndocrinologyToranomon Hospital KajigayaKawasakiJapan
| | - Kyoichiro Tsuchiya
- Department of Diabetes and EndocrinologyUniversity of Yamanashi HospitalYamanashiJapan
| | - Aiko Terakawa
- Department of Diabetes, Endocrinology, and MetabolismCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
| | - Jungo Terasaki
- Department of Internal Medicine (I)Osaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Kan Nagasawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal MedicineIwate Medical UniversityYahabaJapan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | - Tomoyasu Fukui
- Division of Diabetes and EndocrinologyShowa University School of MedicineTokyoJapan
| | - Ichiro Horie
- Department of Endocrinology and MetabolismNagasaki University HospitalNagasakiJapan
| | - Kazuki Yasuda
- Department of Diabetes, Endocrinology, and MetabolismKyorin UniversityMitakaJapan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Public HealthKobe University Graduate School of Health SciencesKobeJapan
| | - Hidekatsu Yanai
- Department of Endocrinology and Metabolism, Kohnodai HospitalNational Center for Global Health and MedicineIchikawaJapan
| | | | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and MetabolismCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
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Sato J, Nakajima K, Mita T, Koshibu M, Sato A, Goto H, Ikeda F, Nishida Y, Aso K, Watada H. Protocol of a Prospective Observational Study on Lifestyle and Quality of Life in Adults with Type 1 Diabetes in Japan. Diabetes Ther 2024; 15:883-892. [PMID: 38363542 PMCID: PMC10951137 DOI: 10.1007/s13300-024-01539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Recent studies have shown that the quality of life (QOL) of people living with type 1 diabetes (T1D) is poor and must be improved. However, the living situation and QOL of adults living with T1D in Japan have not been fully clarified. This study will examine their lifestyle, QOL, and clinical situation, as well as the relationships between them. METHODS This is a prospective, 5-year follow-up observational study. Between December 2019 and September 2021, we enrolled adults in Japan who were living with T1D and receiving insulin therapy, and are acquiring longitudinal clinical data and the responses to seven questionnaires regarding lifestyle and QOL. The primary study outcomes are (1) the relationship between Problem Areas in Diabetes (PAID) scores and various factors including demographic data, clinical characteristics, medical history, lifestyle habits, treatment history, biochemical data, and the scores of questionnaires; and (2) the relationship between Beck Depression Inventory (BDI)-II scores and various factors aforementioned. The secondary outcomes are the relationships between various factors aforementioned and each of the following: (1) blood glucose control, (2) blood lipid control, (3) dietary patterns, (4) fear of hypoglycemia, (5) sleep patterns, and (6) physical activity. PLANNED OUTCOME We registered 352 participants. The median age was 49 (41-63) years, and the median duration of T1D was 13 (8-20) years. All the results will be available in 2026. We expect to clarify the factors associated with decreased QOL, and that this knowledge will contribute to improving QOL in adults in Japan who are living with T1D and receiving insulin therapy. TRIAL REGISTRATION Clinical Trials.gov identifier, UMIN000044088.
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Affiliation(s)
- Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kenichi Nakajima
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mami Koshibu
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ayako Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiromasa Goto
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Fuki Ikeda
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuya Nishida
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Aso
- Aso Clinic, 11-1 Tsutsui-cho, Numazu-shi, Shizuoka, 410-0041, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Kawasaki E, Shimada A, Imagawa A, Abiru N, Awata T, Oikawa Y, Osawa H, Kawabata Y, Kozawa J, Kobayashi T, Takahashi K, Chujo D, Fukui T, Miura J, Yasuda K, Yasuda H, Kajio H, Hanafusa T, Ikegami H. Bivalent GAD autoantibody ELISA improves clinical utility and risk prediction for adult autoimmune diabetes. J Diabetes Investig 2023; 14:570-581. [PMID: 36691729 PMCID: PMC10034953 DOI: 10.1111/jdi.13980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/17/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
AIM/INTRODUCTION To investigate the differences in the clinical significance and glutamic acid decarboxylase autoantibody (GADA) affinity between RIA (RIA-GADA) and ELISA (ELISA-GADA) in patients with type 1 diabetes. METHODS A total of 415 patients with type 1 diabetes were enrolled, including 199 acute-onset type 1 diabetes, 168 slowly progressive type 1 diabetes (SPIDDM), and 48 fulminant type 1 diabetes. GADA affinity was measured by a competitive binding experiment using unlabeled recombinant human GAD65 protein, and the diagnostic performance of both assays and the relationship between GADA affinity and the decline of fasting C-peptide (F-CPR) were examined. RESULTS While the ELISA-GADA displayed a higher sensitivity than the RIA method in diagnosing type 1 diabetes in acute-onset patients, about 40% of SPIDDM patients with low-titer RIA-GADA were determined as negative by the ELISA method. Patients with type 1 diabetes with RIA-GADA alone had an older age of onset, less diabetic ketoacidosis, a higher BMI, and a higher F-CPR compared with patients positive for both RIA-GADA and ELISA-GADA. Additionally, 36% of RIA-GADA-positive patients had low-affinity GADA (<1010 L/mol), which was significantly higher than in the ELISA-GADA-positive patients (4%, P < 0.0001). Furthermore, over a 3 year monitoring period, F-CPR levels decreased in ELISA-GADA-positive SPIDDM, whereas it was maintained in patients with RIA-GADA alone, regardless of GADA affinity. CONCLUSIONS These results suggest that bivalent ELISA for GADA is superior to the RIA method in diagnosing type 1 diabetes. Moreover, the diagnostic superiority of the ELISA-GADA made possible the concurrent identification of SPIDDM patients at high-risk of early progression, and allowed for more accurate clinical diagnosis and management.
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Affiliation(s)
| | - Akira Shimada
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Iruma, Japan
| | - Akihisa Imagawa
- Department of Internal Medicine (I), Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Norio Abiru
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan
| | - Takuya Awata
- Pancreatic Islet Cell Transplantation Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Iruma, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka, Japan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | | | - Daisuke Chujo
- Center for Clinical Research, Toyama University Hospital, Toyama, Japan
| | - Tomoyasu Fukui
- Division of Diabetes and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuki Yasuda
- Department of Diabetes, Endocrinology, and Metabolism, Kyorin University, Mitaka, Japan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka, Japan
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Kawasaki E, Shimada A, Imagawa A, Abiru N, Awata T, Oikawa Y, Osawa H, Kawabata Y, Kozawa J, Kobayashi T, Takahashi K, Chujo D, Fukui T, Miura J, Yasuda K, Yasuda H, Kajio H, Hanafusa T, Ikegami H. Comparing the clinical significance and antigen specificity of insulinoma-associated antigen-2 autoantibodies between radioimmunoassay and enzyme-linked immunosorbent assay in Japanese patients with type 1 diabetes. J Diabetes Investig 2022; 14:58-66. [PMID: 36177861 PMCID: PMC9807156 DOI: 10.1111/jdi.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS/INTRODUCTION This study aimed to investigate the clinical significance and antigen specificity of autoantibodies to insulinoma-associated antigen-2 (IA-2A) by radioimmunoassay (RIA; IA-2A-RIA) and enzyme-linked immunosorbent assay (ELISA; IA-2A-ELISA) in Japanese patients with type 1 diabetes. MATERIALS AND METHODS A total of 338 type 1 diabetic patients were enrolled, including 38 fulminant type 1 diabetes, 168 acute-onset type 1 diabetes and 137 slowly-progressive type 1 diabetes (SPIDDM). The concordance, correlation of autoantibody titer, and the relationship between IA-2A and progression to the insulin-deficient state were examined. Also, competitive assay was used to examine the antigen specificity. RESULTS The prevalence of IA-2A-ELISA was 4-5% lower than that of IA-2A-RIA in both the acute-onset type 1 diabetes and SPIDDM, but the diagnostic sensitivities of both subtypes, when measured in combination with glutamic acid decarboxylase autoantibody, were comparable. The diagnosis of type 1 diabetes using either the RIA or ELISA methods showed substantial agreement with the exponential correlation of autoantibody titers detected by RIA and ELISA. Among the SPIDDM patients, the fasting C-peptide for IA-2A-positive cases by ELISA, but not the RIA method, was significantly lower than in the negative cases (P < 0.05). Furthermore, IA-2A-ELISA proved superior to the RIA method in predicting the progression to insulin deficiency in SPIDDM. Competitive analysis showed that even sera with discrepant results by RIA and ELISA have IA-2-specific autoantibodies. CONCLUSION These results suggest that IA-2A-ELISA is a reliable marker not only for the diagnosis of type 1 diabetes, but also for the prediction of future insulin dependency; that is, detection of IA-2A-ELISA helps identify a subtype of SPIDDM patients who would likely progress onto insulin-deficient state.
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Affiliation(s)
| | - Akira Shimada
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversityIrumaJapan
| | - Akihisa Imagawa
- Department of Internal Medicine (I)Osaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Norio Abiru
- Department of Endocrinology and MetabolismNagasaki University HospitalNagasakiJapan
| | - Takuya Awata
- Pancreatic Islet Cell Transplantation Center, National Center for Global Health and MedicineTokyoJapan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversityIrumaJapan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular GeneticsEhime University Graduate School of MedicineToonJapan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of MedicineOsaka UniversitySuitaJapan
| | | | | | - Daisuke Chujo
- Center for Clinical ResearchToyama University HospitalToyamaJapan
| | - Tomoyasu Fukui
- Division of Diabetes and EndocrinologyShowa University School of MedicineTokyoJapan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal MedicineTokyo Women's Medical University School of MedicineTokyoJapan
| | - Kazuki Yasuda
- Department of Diabetes, Endocrinology, and MetabolismKyorin UniversityMitakaJapan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Public HealthKobe University Graduate School of Health SciencesKobeJapan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and MetabolismNational Center for Global Health and MedicineTokyoJapan
| | | | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
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