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Li W, Cheng Z, Song Y, Fang Y, Yang M, Zhang M. Is diabetic retinopathy affected by diabetes type? A retrospective study using electronic medical record data from patients with latent autoimmune diabetes in adults, type 1 diabetes, and type 2 diabetes. Acta Diabetol 2021; 58:1503-1511. [PMID: 34121168 PMCID: PMC8505353 DOI: 10.1007/s00592-021-01748-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS To determine whether the occurrence of diabetic retinopathy (DR) and its related factors are affected by diabetes type (latent autoimmune diabetes in adults [LADA], type 1 diabetes mellitus [T1DM], type 2 diabetes mellitus [T2DM]). METHODS LADA patients were matched for age (± 2 years) and sex to T1DM (1:1) and T2DM (1:2) patients. Retrieved variables included demographic characteristics, diabetes history, laboratory test findings, and history of DR screening, etc. Multiple logistic regression analysis was applied to identify influencing factors of DR. A decision tree was used to explore interactions between diabetes type and other influencing factors of DR. RESULTS We included 110 LADA, 101 T1DM, and 220 T2DM patients. DR prevalence was 26.4% in LADA patients, lower than that in T1DM (50.5%) and T2DM (47.7%) patients (P < 0.001). Logistic regression analysis demonstrated that diabetes duration (OR = 1.15, 95% CI: 1.1-1.26, P < 0.001) and diabetic nephropathy (DN) (OR = 42.39, 95% CI: 10.88-165.11, P < 0.001) were independent risk factors for DR, and regular DR screening (OR = 0.33, 95% CI: 0.16-0.69, P = 0.003) was an independent protective factor. Decision tree analysis showed that in patients without DN with a diabetes duration of at least 10.5 years, T1DM and LADA patients had a higher incidence of DR than T2DM patients (72.7% vs. 55.1%). CONCLUSIONS The prevalence of DR in diabetes patients was affected by diabetes duration, DN occurrence, and regular DR screening. Diabetes type indirectly affects DR occurrence through its interaction with diabetes duration and DN. Correct LADA diagnosis is necessary, and DR screening needs to be well-implemented.
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Affiliation(s)
- Wanyue Li
- Medical School of Chinese PLA, Beijing, China
| | - Zifang Cheng
- The Northern Medical District of Chinese PLA General Hospital, Beijing, China
| | - Yanan Song
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yifan Fang
- Medical School of Chinese PLA, Beijing, China
| | - Ming Yang
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Maonian Zhang
- Medical School of Chinese PLA, Beijing, China.
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China.
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Widén C, Holmer H, Sättlin S, Renvert S, Lernmark Å, Persson GR. Periodontal conditions, retinopathy, and serum markers in individuals with type 1 diabetes. J Periodontol 2020; 91:1436-1443. [PMID: 32484239 DOI: 10.1002/jper.19-0641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/18/2020] [Accepted: 04/19/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of diabetes is high and increasing. Periodontitis has been identified as a risk factor in both type 1 and 2 diabetes. The study purpose was to assess periodontal conditions, retinopathy, and serum glutamic acid decarboxylase antibody (GADA) titers in relation to retinopathy in individuals with type 1 diabetes (T1D). METHODS The study is a case series. Adult individuals with a diagnosis of T1D (n = 85) monitored ≥5 years were recruited from an endocrinology clinic. Peripheral venous blood samples were analyzed including assessments of serum HbA1c levels and GADA titers. Medical and periodontal conditions were examined, and the data assessed. Independent t tests, binary and multivariate analyses, χ2 and odds ratios were employed. RESULTS Gingivitis was found in 68.2%, periodontitis in 21.2%, and retinopathy in 64.7%, GADA (≥35 U/mL) in 54.1%, and serum HbA1c > 48 mmol/mol in 94.3% of the individuals. The unadjusted odds ratio for periodontitis to differentiate a diagnosis of retinopathy was 7.3 (95%CI 1.6, 4.4, P <0.01). Multivariate analyses identified the following dependent factors to differentiate retinopathy; age, T1D duration, gingivitis, periodontitis at P < 0.001, sex, and serum GADA at P < 0.01, and by the number of remaining teeth at P < 0.05. CONCLUSION Retinopathy as a complication to T1D is linked to the duration of diabetes, age of the individual and with increasing severity to periodontitis. Periodontal intervention studies are warranted.
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Affiliation(s)
- Cecilia Widén
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - Susanna Sättlin
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Blekinge Institute of Technology, Karlskrona, Sweden
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, University Hospital, Malmö, Sweden
| | - G Rutger Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Department of Oral Medicine, University of Washington, Seattle, WA, USA.,Department of Periodontics, University of Washington, Seattle, WA, USA
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Maddaloni E, Coleman RL, Agbaje O, Buzzetti R, Holman RR. Time-varying risk of microvascular complications in latent autoimmune diabetes of adulthood compared with type 2 diabetes in adults: a post-hoc analysis of the UK Prospective Diabetes Study 30-year follow-up data (UKPDS 86). Lancet Diabetes Endocrinol 2020; 8:206-215. [PMID: 32032540 DOI: 10.1016/s2213-8587(20)30003-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Latent autoimmune diabetes of adulthood (LADA) differs in clinical features from type 2 diabetes. Whether this difference translates into different risks of complications remains controversial. We examined the long-term risk of microvascular complications in people enrolled in the UK Prospective Diabetes Study (UKPDS), according to their diabetes autoimmunity status. METHODS We did a post-hoc analysis of 30-year follow-up data from UKPDS (UKPDS 86). UKPDS participants with diabetes autoantibody measurements available and without previous microvascular events were included. Participants with at least one detectable autoantibody were identified as having latent autoimmune diabetes, and those who tested negative for all autoantibodies were identified as having type 2 diabetes. The incidence of the primary composite microvascular outcome (first occurrence of renal failure, renal death, blindness, vitreous haemorrhage, or retinal photocoagulation) was compared between adults with latent autoimmune diabetes and those with type 2 diabetes. The follow-up ended on Sept 30, 2007. Baseline and updated 9-year mean values of potential confounders were tested in Cox models to adjust hazard ratios (HRs). UKPDS is registered at the ISRCTN registry, 75451837. FINDINGS Among the 5028 participants included, 564 had latent autoimmune diabetes and 4464 had type 2 diabetes. After median 17·3 years (IQR 12·6-20·7) of follow-up, the composite microvascular outcome occurred in 1041 (21%) participants. The incidence for the composite microvascular outcome was 15·8 (95% CI 13·4-18·7) per 1000 person-years in latent autoimmune diabetes and 14·2 (13·3-15·2) per 1000 person-years in type 2 diabetes. Adults with latent autoimmune diabetes had a lower risk of the composite outcome during the first 9 years of follow-up than those with type 2 diabetes (adjusted HR 0·45 [95% CI 0·30-0·68], p<0·0001), whereas in subsequent years their risk was higher than for those with type 2 diabetes (1·25 [1·01-1·54], p=0·047). Correcting for the higher updated 9-year mean HbA1c seen in adults with latent autoimmune diabetes than in those with type 2 diabetes explained entirely their subsequent increased risk for the composite microvascular outcome (adjusted HR 0·99 [95% CI 0·80-1·23], p=0·93). INTERPRETATION At diabetes onset, adults with latent autoimmune diabetes have a lower risk of microvascular complications followed by a later higher risk of complications than do adults with type 2 diabetes, secondary to worse glycaemic control. Implementing strict glycaemic control from the time of diagnosis could reduce the later risk of microvascular complications in adults with latent autoimmune diabetes. FUNDING European Foundation for the Study of Diabetes Mentorship Programme (AstraZeneca).
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Affiliation(s)
- Ernesto Maddaloni
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy; Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
| | - Ruth L Coleman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Olorunsola Agbaje
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Raffaella Buzzetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Pozzilli P, Pieralice S. Latent Autoimmune Diabetes in Adults: Current Status and New Horizons. Endocrinol Metab (Seoul) 2018; 33:147-159. [PMID: 29947172 PMCID: PMC6021307 DOI: 10.3803/enm.2018.33.2.147] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 12/16/2022] Open
Abstract
Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA. To date the heterogeneity of LADA does not allow to establish a priori treatment algorithm and no specific guidelines for LADA therapy are available. These subjects are mostly treated as affected by type 2 diabetes, a factor that might lead to the progression to insulin-dependency quickly. A personalised medicine approach is necessary to attain optimal metabolic control and preserve β-cell function to decrease the risk of long-term diabetes complications. Recent data concerning the use of oral antidiabetic agents as dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists indicate up-and-coming results in term of protect C-peptide levels and improving glycaemic control. This review summarises current knowledge on LADA, emphasising controversies regarding its pathophysiology and clinical features. Moreover, we discuss data available about novel therapeutic approaches that can be considered for prevention of β-cell loss in LADA.
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Affiliation(s)
- Paolo Pozzilli
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary, University of London, London, UK.
| | - Silvia Pieralice
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
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Wod M, Thomsen RW, Pedersen L, Yderstraede KB, Beck-Nielsen H, Højlund K. Lower mortality and cardiovascular event rates in patients with Latent Autoimmune Diabetes In Adults (LADA) as compared with type 2 diabetes and insulin deficient diabetes: A cohort study of 4368 patients. Diabetes Res Clin Pract 2018. [PMID: 29518492 DOI: 10.1016/j.diabres.2018.02.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Latent Autoimmune Diabetes in Adults (LADA) is the second most common form of diabetes, but data on its clinical course and prognosis are scarce. We compared long-term risk of mortality and cardiovascular outcomes in patients with LADA, type 2 diabetes mellitus (T2D), and insulin deficient diabetes (IDD). METHODS We conducted a cohort study of 4368 adults with diabetes referred to the Department of Endocrinology, Odense University Hospital, Denmark, between 1997 and 2012. Data on comorbidity, cardiovascular outcomes and death were obtained from prospective medical databases. We compared adjusted hazard ratios (HRs) of mortality and cardiovascular outcomes for patients with LADA, T2D and IDD, respectively. RESULTS We included 327 patients with LADA, 3539 with T2D and 502 with IDD. At diagnosis, patients with LADA were older (50 years (IQR 37-59)) than IDD patients (40 years (IQR 28-52)), but younger than patients with T2D (55 years (IQR 45-64)). During a median follow-up period of 6.6 years (IQR 3.4-9.4), patients with IDD had higher mortality than patients with LADA, age- and gender-adjusted HR 2.2 (95% CI, 1.5-3.2). T2D also conferred higher mortality than LADA, HR 1.4 (95% CI, 1.0-1.9). Compared with LADA patients, cardiovascular outcome rates were increased both with IDD, HR 1.2 (95% CI, 0.7-2.0) and T2D, HR 1.2 (95% CI, 0.8-1.8), with the strongest association observed for T2D vs. LADA and acute myocardial infarction HR 1.7 (95% CI, 0.8-3.5). CONCLUSION LADA seems to be associated with lower mortality and lower risk of cardiovascular events, compared with both T2D and IDD.
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Affiliation(s)
- Mette Wod
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark; Epidemiology, Biostatistics & Biodemography, University of Southern Denmark, Odense, Denmark.
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Knud B Yderstraede
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Henning Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Kurt Højlund
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark; Section of Molecular Diabetes & Metabolism, Institute of Clinical Research and Institute of Molecular Medicine, University of Southern Denmark, Denmark
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Siraj ES, Homko C, Wilson LA, May P, Rao AD, Calles J, Farrugia G, Hasler WL, Koch KL, Nguyen L, Snape WJ, Abell TL, Sarosiek I, McCallum RW, Pasricha PJ, Clarke J, Tonascia J, Hamilton F, Parkman HP. Islet Cell Associated Autoantibodies and C-Peptide Levels in Patients with Diabetes and Symptoms of Gastroparesis. Front Endocrinol (Lausanne) 2018; 9:32. [PMID: 29487566 PMCID: PMC5816742 DOI: 10.3389/fendo.2018.00032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Individuals with diabetes are at increased risk for complications, including gastroparesis. Type 1 diabetes mellitus (T1DM) is an autoimmune disorder resulting in decreased beta-cell function. Glutamic acid decarboxylase-65 antibody (GADA) is the most commonly used test to assess autoimmunity while C-peptide level is used to assess beta-cell function. Patients with type 2 diabetes mellitus (T2DM), who are GADA positive, are labeled latent autoimmune diabetes in adults (LADA). OBJECTIVE To characterize patients with T1 and T2DM who have symptoms of gastroparesis using GADA and C-peptide levels and to look for association with the presence of gastroparesis and its symptom severity. DESIGN 113 T1DM and 90 T2DM patients with symptoms suggestive of gastroparesis were studied. Symptom severity was assessed using Gastroparesis Cardinal Symptom Index (GCSI). Serum samples were analyzed for GADA and C-peptide. RESULTS Delayed gastric emptying was present in 91 (81%) of T1DM and 60 (67%) of T2DM patients (p = 0.04). GADA was present in 13% of T2DM subjects [10% in delayed gastric emptying and 20% in normal gastric emptying (p = 0.2)]. Gastric retention and GCSI scores were mostly similar in GADA positive and negative T2DM patients. GADA was present in 45% of T1DM subjects [46% in delayed gastric emptying and 41% in normal gastric emptying (p = 0.81)]. Low C-peptide levels were seen in 79% T1DM patients and 8% T2DM. All seven T2DM patients with low C-peptide were taking insulin compared to 52% of T2DM with normal C-peptide. CONCLUSION GADA was present in 13% while low C-peptide was seen in 8% of our T2DM patients with symptoms of gastroparesis. Neither did correlate with degree of delayed gastric emptying or symptom severity. CLINICALTRIALSGOV IDENTIFIER NCT01696747.
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Affiliation(s)
- Elias S. Siraj
- Division of Endocrinology and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Elias S. Siraj,
| | - Carol Homko
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | | | - Patrick May
- Johns Hopkins University, Baltimore, MD, United States
| | - Ajay D. Rao
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Jorge Calles
- Case Western Reserve University, Cleveland, OH, United States
| | | | | | | | - Linda Nguyen
- Stanford University, Palo Alto, CA, United States
| | - William J. Snape
- California Pacific Medical Center, San Francisco, CA, United States
| | | | - Irene Sarosiek
- Texas Tech University Health Science Center, El Paso, TX, United States
| | | | | | - John Clarke
- Johns Hopkins University, Baltimore, MD, United States
| | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Henry P. Parkman
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
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Buzzetti R, Zampetti S, Maddaloni E. Adult-onset autoimmune diabetes: current knowledge and implications for management. Nat Rev Endocrinol 2017; 13:674-686. [PMID: 28885622 DOI: 10.1038/nrendo.2017.99] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus.
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Affiliation(s)
- Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Simona Zampetti
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Via Álvaro del Portillo 21, 00128, Rome, Italy
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Hernández M, López C, Real J, Valls J, Ortega-Martinez de Victoria E, Vázquez F, Rubinat E, Granado-Casas M, Alonso N, Molí T, Betriu A, Lecube A, Fernández E, Leslie RD, Mauricio D. Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes. Cardiovasc Diabetol 2017; 16:94. [PMID: 28750634 PMCID: PMC5532780 DOI: 10.1186/s12933-017-0576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND LADA is probably the most prevalent form of autoimmune diabetes. Nevertheless, there are few data about cardiovascular disease in this group of patients. The aim of this study was to investigate the frequency of carotid atherosclerotic plaques in patients with LADA as compared with patients with classic type 1 diabetes and type 2 diabetes. METHODS Patients with LADA were matched for age and gender in different proportions to patients with type 2 diabetes, and classic type 1 diabetes. None of the patients had clinical cardiovascular disease. All subjects underwent B-mode carotid ultrasound to detect atheroma plaques. Demographics were obtained from all subjects. RESULTS We included 71 patients with LADA, 191 patients with type 2 diabetes and 116 patients with type 1 diabetes. Carotid atherosclerosis was more frequent in patients with LADA compared with type 2 diabetes (73.2% vs. 56.9%, P = 0.0018) and classic type 1 diabetes (57.1%, P = 0.026); these changes occurred despite healthier macrovascular risk profiles in the former. Age (P < 0.001), smoking (P = 0.003) and hypertension (P = 0.019) were independently associated with carotid atherosclerosis. Multiple plaques were also more frequent in patients with LADA as compared with classic type 1 diabetes and type 2 diabetes (45.1% and 33.6% vs. 27.2%, respectively, P = 0.022). The frequency of carotid plaques increased with increasing diabetes duration in LADA patients compared with type 2 diabetes (85.7% vs. 58.8%, inverse OR 5.72 [1.5-21.8]; P = 0.009). CONCLUSIONS LADA patients do not present with less carotid atherosclerosis than patients with type 1 and type 2 diabetes. Their macrovascular risk occurs despite a healthier macrovascular risk profile than those patients with type 2 diabetes.
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Affiliation(s)
- Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Carolina López
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Joan Valls
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | - Emilio Ortega-Martinez de Victoria
- Department of Endocrinology and Nutrition, CIBEROBN-Spanish Biomedical Research Centre in Physiopathology of Obesity, Hospital Clínic, Barcelona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | | | - Minerva Granado-Casas
- Nursing School, Universitat de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Teresa Molí
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Elvira Fernández
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Richard David Leslie
- The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Dídac Mauricio
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
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Roh MO, Jung CH, Kim BY, Mok JO, Kim CH. The prevalence and characteristics of latent autoimmune diabetes in adults (LADA) and its relation with chronic complications in a clinical department of a university hospital in Korea. Acta Diabetol 2013; 50:129-34. [PMID: 20953640 DOI: 10.1007/s00592-010-0228-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
Few studies were performed to evaluate the prevalence of latent autoimmune diabetes in adults (LADA) and the difference of chronic complications between LADA, T1DM, and T2DM in Korean. The aim of this study is to establish the prevalence of LADA in a diabetic clinic of Soonchunhyang University hospital and to compare the phenotypic characteristics according to DM classification based on positivity of glutamic acid decarboxylase antibodies (GADA). Also, another important point concerns the occurrence of diabetes chronic microvascular complications in LADA. 323 patients who were checked GADA among diabetic patients admitted at Soonchunhyang University hospital were recruited. Twenty-eight patients (8.7%) were identified as positive for GADA. 11.5% (n = 37) were diagnosed with T1DM and 5.3% (n = 17) were diagnosed with LADA. GADA titer showed significant negative correlation with age of onset, total cholesterol (TC), triglyceride (TG), fasting C-peptide, stimulated C-peptide, BMI, and positive correlation with HbA1C and HDL-C. Compared with those that tested negative for GADA, patients with GADA positive had lower values of onset age, BMI, TC, TG, LDL-C, fasting, and stimulated C-peptide levels and higher values of HbA1C. A significant gradual increase of values was observed for the onset age, BMI, SBP, DBP, fasting, and stimulated C-peptide across the T1DM, LADA, and T2DM subgroups. Concerning the chronic complications there was no difference in prevalence of retinopathy, neuropathy and nephropathy between three groups. Of LADA patients, 12 patients were receiving insulin treatment and mean time to insulin initiation was about 37 months. In conclusion, because our study suggests LADA subgroups in Korea appear to have a faster decline in C-peptide levels, it is worth detecting the patients with LADA early and effort to preserve beta cell function. Furthermore, our results showed that the prevalence of microvascular complication was comparable between the subgroups.
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Affiliation(s)
- Mi-Oh Roh
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, # 108 Jung-Dong, Wonmi-Ku, Kyunggi-Do, Bucheon, 110-746, Republic of Korea
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Jensen RA, Agardh E, Lernmark A, Gudbjörnsdottir S, Smith NL, Siscovick DS, Törn C. HLA genes, islet autoantibodies and residual C-peptide at the clinical onset of type 1 diabetes mellitus and the risk of retinopathy 15 years later. PLoS One 2011; 6:e17569. [PMID: 21412422 PMCID: PMC3055880 DOI: 10.1371/journal.pone.0017569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 02/03/2011] [Indexed: 11/17/2022] Open
Abstract
Aims/Hypothesis HLA genes, islet autoantibodies and residual C-peptide were studied to
determine the independent association of each exposure with diabetic
retinopathy (DR), 15 years after the clinical onset of type 1 diabetes in
15–34 year old individuals. Methods The cohort was identified in 1992 and 1993 by the Diabetes Incidence Study in
Sweden (DISS), which investigates incident cases of diabetes for patients
between 15 and 34 years of age. Blood samples at diagnosis were analyzed to
determine HLA genotype, islet autoantibodies and serum C-peptide. In 2009,
fundus photographs were obtained from patient records. Study measures were
supplemented with data from the Swedish National Diabetes Registry. Results The prevalence of DR was 60.2% (148/246). Autoantibodies against the
65 kD isoform of glutamate decarboxylase (GADA) at the onset of clinical
diabetes increased the risk of DR 15 years later, relative risk 1.12 for
each 100 WHO units/ml, [95% CI 1.02 to 1.23]. This equates
to risk estimates of 1.27, [95% CI 1.04 to 1.62] and 1.43,
[95% CI 1.06 to 1.94] for participants in the highest
25th (GADA>233 WHO units/ml) and 5th percentile
(GADA>319 WHO units/ml) of GADA, respectively. These were adjusted for
duration of diabetes, HbA1c, treated hypertension, sex, age at
diagnosis, HLA and C-peptide. Islet cell autoantibodies, insulinoma-antigen
2 autoantibodies, residual C-peptide and the type 1 diabetes associated
haplotypes DQ2, DQ8 and DQ6 were not associated with DR. Conclusions Increased levels of GADA at the onset of type 1 diabetes were associated with
DR 15 years later. These results, if confirmed, could provide additional
insights into the pathogenesis of the most common microvascular complication
of diabetes and lead to better risk stratification for both patient
screenings and DR treatment trials.
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Affiliation(s)
- Richard A Jensen
- Cardiovascular Health Research Unit, School of Medicine, and the Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America.
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11
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Chung JO, Cho DH, Chung DJ, Chung MY. Chronic Complications in Adult Diabetic Patients with and without GAD Antibody. KOREAN DIABETES JOURNAL 2009. [DOI: 10.4093/kdj.2009.33.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jin Ook Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Hyeok Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Jin Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Min Young Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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12
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Myhill P, Davis WA, Bruce DG, Mackay IR, Zimmet P, Davis TME. Chronic complications and mortality in community-based patients with latent autoimmune diabetes in adults: the Fremantle Diabetes Study. Diabet Med 2008; 25:1245-50. [PMID: 19046207 DOI: 10.1111/j.1464-5491.2008.02562.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To compare (i) the prevalence and incidence of chronic complications and (ii) cardiac and all-cause mortality in community-based patients with latent autoimmune diabetes in adults (LADA) with those in Type 2 diabetic patients without antibodies to glutamic acid decarboxylase (GAD). METHODS Of the 1294 patients with clinically-defined Type 2 diabetes recruited to the longitudinal, observational Fremantle Diabetes Study between 1993 and 1996, 1255 (97%) had GAD antibodies measured at baseline. Complications were ascertained using standard criteria in patients returning for annual assessments until November 2001. Data on hospital admissions and mortality were available to the end of June 2006. Cox proportional hazards modelling was used to determine independent predictors of first occurrence of complications and cardiac and all-cause mortality. RESULTS Forty-five (3.6%) subjects had LADA. Compared with the GAD antibody-negative patients, they had a similar prevalence and incidence of coronary heart (P = 0.48 and 0.80, respectively) and cerebrovascular (P = 0.64 and 0.29) disease and cardiac and all-cause mortality (P = 0.62 and 0.81, respectively). There was also a similar prevalence and incidence of retinopathy (P = 0.22 and 0.64, respectively) and neuropathy (P = 0.25 and 0.95), but microalbuminuria was less frequent both at baseline and during follow-up in the LADA subgroup in unadjusted models (P = 0.046) and after adjustment for other risk factors (P = 0.014 and 0.013). CONCLUSIONS Except for a lower prevalence and incidence of nephropathy, LADA patients have a similar risk of complications and death to patients with clinically-diagnosed Type 2 diabetes without GAD antibodies. Cardiovascular risk factor management in LADA should, therefore, be as intensive as that for GAD antibody-negative patients.
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Affiliation(s)
- P Myhill
- School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, WA, Australia
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13
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Arikan E, Sabuncu T, Ozer EM, Hatemi H. The clinical characteristics of latent autoimmune diabetes in adults and its relation with chronic complications in metabolically poor controlled Turkish patients with Type 2 diabetes mellitus. J Diabetes Complications 2005; 19:254-8. [PMID: 16112499 DOI: 10.1016/j.jdiacomp.2005.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Revised: 01/21/2005] [Accepted: 02/15/2005] [Indexed: 11/26/2022]
Abstract
It has been reported that some patients with Type 2 diabetes mellitus (DM) have latent autoimmune diabetes in adults (LADA) and may show different clinical characteristics than those with Type 2 DM. We aimed to determine the ratio and clinical features of LADA in patients with diagnosed initially as Type 2 DM. We measured glutamic acid decarboxylase antibodies (GADA) in 54 patients, diagnosed clinically with Type 2 DM. Of 54 patients, 17 (31%) were GADA positive. GADA-positive patients had significantly earlier diabetes onset age (P<.001), lower BMI (P<.05), and lower serum C-peptide value (P<.001) than did those who were GADA negative. A higher proportion of the GADA-positive patients were receiving insulin therapy (P<.01). With respect to the duration of DM, familial history of DM, and the levels of blood pressures, fasting plasma glucose, and HbA1c, there was no difference between the two groups. Nephropathy and retinopathy were more frequent in GADA-positive than in GADA-negative patients. The prevalence of neuropathy was comparable between the two groups. GADA was negatively associated with BMI, C-peptide levels, and diabetes-onset age, but positively related to retinopathy, nephropathy, and insulin treatment. This study indicated that the important portion of the patients who were initially diagnosed as Type 2 DM may have LADA. In Type 2 diabetic patients who have lower BMI and diagnosis of diabetes in relatively younger age, the possibility of LADA should be taken into consideration. The higher prevalence of nephropathy and retinopathy in GADA-positive patients also suggests the importance of early diagnosis and strict metabolic control in these patients.
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Affiliation(s)
- Ender Arikan
- Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey.
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Nabhan F, Emanuele MA, Emanuele N. Latent autoimmune diabetes of adulthood. Unique features that distinguish it from types 1 and 2. Postgrad Med 2005; 117:7-12. [PMID: 15782668 DOI: 10.3810/pgm.2005.03.1597] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A number of patients with poor glycemic control receive the diagnosis of type 2 diabetes despite the fact that they do not exhibit some of the traditional characteristics of the disease, such as obesity. A more accurate diagnosis for many of these patients is latent autoimmune diabetes of adulthood (LADA). In this article, Dr Nabhan and coauthors describe features that LADA has in common with type 1 and type 2 diabetes, as well as those that distinguish LADA from these more widely recognized forms of diabetes. The authors also describe the pathogenesis of the disease, potential complications, and treatment options.
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Affiliation(s)
- Fadi Nabhan
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Current literature in diabetes. Diabetes Metab Res Rev 2002; 18:491-8. [PMID: 12469363 DOI: 10.1002/dmrr.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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