scholarly journals Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Lúcia Fadiga ◽  
Joana Saraiva ◽  
Diana Catarino ◽  
João Frade ◽  
Miguel Melo ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Diabetic Nephropathy ◽  
Statistical Difference ◽  
Autoimmune Diabetes ◽  
Microvascular Complications ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Adult Onset ◽  
C Peptide ◽  
Autoimmune Aetiology

Abstract Introduction Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA. Methods We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p < 0.001). The mean BMI at diagnosis was 24.1 kg/m2 in T1DM group and 26.1 kg/m2 in LADA group (p = 0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p = 0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p < 0.001). The median daily insulin dose was 40 IU for T1DM (0.58 IU/kg) and 33.5 IU for LADA (0.57 IU/kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p = 0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p = 0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p = 0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

scholarly journals Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

2020 ◽  
Author(s):  
Lúcia Fadiga ◽  
Joana Saraiva ◽  
Diana Catarino ◽  
João Frade ◽  
Miguel Melo ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Diabetic Nephropathy ◽  
Statistical Difference ◽  
Autoimmune Diabetes ◽  
Microvascular Complications ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Adult Onset ◽  
C Peptide ◽  
Autoimmune Aetiology

Abstract Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR – 15) for T1DM and 42 years (IQR – 15) for LADA (p=0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p<0.001). The mean BMI at diagnosis was 24.1Kg/m2 in T1DM group and 26.1Kg/m2 in LADA group (p=0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p=0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p<0.001). The median daily insulin dose was 40IU for T1DM (0.58IU/Kg) and 33.5IU for LADA (0.57IU/Kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p=0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p=0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p=0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

scholarly journals Adult-onset Autoimmune Diabetes: Comparative Analysis of Classical and Latent Presentation

2020 ◽  
Author(s):  
Lúcia Fadiga ◽  
Joana Saraiva ◽  
Diana Catarino ◽  
João Frade ◽  
Miguel Melo ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Diabetic Nephropathy ◽  
Statistical Difference ◽  
Autoimmune Diabetes ◽  
Microvascular Complications ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Adult Onset ◽  
C Peptide ◽  
Autoimmune Aetiology

Abstract Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR – 15) for T1DM and 42 years (IQR – 15) for LADA (p=0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p<0.001). The mean BMI at diagnosis was 24.1Kg/m2 in T1DM group and 26.1Kg/m2 in LADA group (p=0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p=0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p<0.001). The median daily insulin dose was 40IU for T1DM (0.58IU/Kg) and 33.5IU for LADA (0.57IU/Kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p=0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p=0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p=0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome (p=0.005). Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

scholarly journals MON-649 Application of the New Cluster-Based Classification of Adult Onset Diabetes in a South Texas Veteran Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jonathan Trejo ◽  
Lyan Gondin Hernandez ◽  
Lucy M A Esteve ◽  
Libia Vasquez ◽  
Sheila Pinkson ◽  
...  
Keyword(s):  
Autoimmune Diabetes ◽  
Microvascular Complications ◽  
South Texas ◽  
Adult Onset ◽  
Insulin Deficiency ◽  
Diabetes Clinic ◽  
C Peptide ◽  
Onset Diabetes ◽  
Adult Onset Diabetes

Abstract Recently a cluster-based classification of disease phenotypes has been developed as a tool to aid in improved characterization and management of diabetes. The majority of these studies have been completed in European populations, but it is unclear if these are applicable to other populations. Using these cohorts, we categorized patients in a South Texas VA diabetes clinic to evaluate if these phenotypes apply to that population. A retrospective cohort study was completed from August 2019 through October 2019, in which 120 patients’ records in the Audie Murphy VA Diabetes Clinic were reviewed for presence of macro and microvascular complications, type of anti-diabetic medication, lipid profile and HbA1c levels, and fasting C-peptide and GADab status. 86 patients who had anti-GADab and C-Peptide levels measured were then stratified into diabetic phenotype cohorts as defined by Ahlqvist et al. 2018, based on presence of diabetes associated autoantibodies, fasting C-peptide level, insulin use &gt;200 U/day, BMI, and age &gt;65. Six subjects belonged to the Severe Autoimmune Diabetes (SAID) cohort, with average GADab 713±301IU; 66% of the cohort had nephropathy, 33% had retinopathy. The Severe Insulin Deficiency (SIDD) cohort had 9 patients, with average fasting C-peptide of 0.58±0.08ng/ml, 44% of the cohort had retinopathy, nephropathy and CAD as complications. The Severe Insulin Resistant (SIRD) cohort had 26 patients; fasting C-peptide was 4.94±0.43ng/ml, 73% had nephropathy, 38% retinopathy and 46% CAD. The Mild Obesity Related (MOD) cohort had 35 patients with average BMI of 35±0.6 kg/m2 and average A1c 7.9±0.2%. Nephropathy was the most prevalent complication, present in 49% of the cohort. The Mild Age Related (MARD) cohort had 10 patients, with average age of 71±1.0 years, with nephropathy and CAD present in 66% of the cohort. The highest gross prevalence of nephropathy was in the SIRD cohort, whereas highest prevalence of retinopathy was in the SIDD cohort, both of which are concordant with the recently reported study, although not statistically significant (p=0.28 and 0.65, respectively). There was no difference in prevalence of CAD between the different categories of diabetes. These findings in a South Texas VA diabetes clinic population reflect agreement in diabetes associated complications in clusters of diabetes based on insulin resistance and insulin deficiency. Targeted intensification of therapy based on the major underlying pathophysiologic abnormalities may delay or prevent micro and macrovascular complications. 1. Ahlqvist E, et al. Novel Subgroups of Adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Endocrinology and Diabetes. 2018;6: 361-369.

scholarly journals Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

2007 ◽  
Vol 51 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Pedro Weslley S. Rosário ◽  
Janice Sepulveda Reis ◽  
Tiago Alvarenga Fagundes ◽  
Maria Regina Calsolari ◽  
Ricardo Amim ◽  
...  
Keyword(s):  
Autoimmune Diabetes ◽  
Insulin Dose ◽  
Hdl Cholesterol ◽  
Insulin Requirement ◽  
C Peptide ◽  
Beta Cell Failure ◽  
Latent Autoimmune Diabetes ◽  
Antibody Titers

OBJECTIVE: To determine the clinical and laboratory parameters and the progression to insulin requirement in two groups of LADA patients separated according to GADA titers, and to evaluate the benefit of early insulinization in patients at high risk of premature beta-cell failure (high GADA titers). METHODS: Among the diabetic adults seen at our service and screened for GADA at diagnosis, 54 were diagnosed with LADA and classified as having low (> 1 U/ml and < 17.2 U/ml) or high (> 17.2 U/ml) GADA titers. Fifty-four patients with type 2 diabetes (GADA-) were selected for comparison. In addition, 24 patients who had GADA titers > 20 U/ml and who were not initially insulinized were compared to 16 patients who were insulinized at diagnosis. RESULTS: Insulin resistance was higher in the GADA- group, followed by patients with low GADA titers. BMI and the frequency of arterial hypertension, elevated triglycerides and reduced HDL cholesterol were lower in the high GADA+ group, with no difference between the GADA- or low GADA+ groups. The high GADA+ group showed a greater reduction and lower levels of C-peptide and required insulin earlier during follow-up. Patients with GADA titers > 20 U/ml and insulinized early presented no significant variation in C-peptide levels, had better glycemic control and required a lower insulin dose than patients who were insulinized later. CONCLUSION: We agree that patients with LADA should be differentiated on the basis of GADA titers and that patients with GADA titers > 20 U/ml benefit from early insulinization.

Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emine Ayça Cimbek ◽  
Aydın Bozkır ◽  
Deniz Usta ◽  
Nazım Ercüment Beyhun ◽  
Ayşenur Ökten ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Hemoglobin A1c ◽  
Insulin Dose ◽  
Age At Onset ◽  
Insulin Requirement ◽  
C Peptide ◽  
Factors Associated ◽  
Daily Insulin

Abstract Objectives Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. Results Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). Conclusions Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.

Identifying latent autoimmune diabetes in adults in Korea: The role of C-peptide and metabolic syndrome

2009 ◽  
Vol 83 (2) ◽  
pp. e62-e65 ◽  
Author(s):  
Seung-Hwan Lee ◽  
Hyuk-Sang Kwon ◽  
Soon-Jib Yoo ◽  
Yu-Bai Ahn ◽  
Kun-Ho Yoon ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Autoimmune Diabetes ◽  
C Peptide ◽  
Latent Autoimmune Diabetes

Metabolic Syndrome in Adult-Onset Latent Autoimmune Diabetes

2005 ◽  
Vol 3 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Xia Li ◽  
Zhiguang Zhou ◽  
Gan Huang ◽  
Heng Su ◽  
Xiang Yan ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Autoimmune Diabetes ◽  
Adult Onset ◽  
Latent Autoimmune Diabetes

scholarly journals Approach to Diagnosis and Management Latent Autoimmune Diabetes in Adults: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A368-A369
Author(s):  
Dita Gemiana ◽  
Andi Alfian ◽  
Dicky Levenus Tahapary ◽  
Andhika Rachman
Keyword(s):  
Glutamic Acid ◽  
Glutamic Acid Decarboxylase ◽  
Autoimmune Diabetes ◽  
Blood Gas Analysis ◽  
Insulin Requirement ◽  
Gas Analysis ◽  
Acid Decarboxylase ◽  
Family History Of Diabetes ◽  
C Peptide ◽  
Latent Autoimmune Diabetes

Abstract Introduction:. Latent Autoimmune Diabetes in Adults (LADA) is used to describe a form of autoimmune diabetesthat has a later onset and a slower progression toward an absolute insulin requirement. The presence of pancreaticauto antibodies especially to Glutamic acid decarboxylase (GAD65) is the best single marker required to diagnoseLADA. Case Illustration. A 35-year-old male came to emergency room with complaints of shortness of breath since twodays before admission. Tightness was not affected by activities or changes in position. The patient also hadcomplaints of vomiting since 3 days before admission. There was a weight loss of 10 kg in the last 1 month andcomplaint urinated frequently. There is no family history of diabetes and autoimmunity. The patient’s blood sugarlevel was 422 mg/dL, blood ketone was 5.6 mmol/L, and the blood gas analysis showed metabolic acidosis. The c-peptide level was 0.35 ng/mL (1.1 - 4.4 ng/mL). Patients was positive for glutamic acid decarboxylase (GAD)autoantibodies. Patients was diagnose with LADA and treated with basal insulin 1x36 unit and prandial insulin 3x20unit. Discussion: C-peptide is mostly undetectable in classical T1DM and normal or high in patients with newlydiagnosed T2DM, whereas individuals with LADA tend to have low but still detectable C-peptide values at the timeof diagnosis. Thus, islet autoantibodies screening, especially GADA, should be required as a second step for patientswith adult-onset diabetes showing low serum C-peptide. To date, evidence shows that patients with LADA shouldbe treated with insulin at an earlier stage. Conclusion: Routine GADA screening should be considered. However, since testing for islet-cell autoantibodiesmay not always be indicated because of high costs, C-peptide measurement may be a useful tool to rule outdiagnosis of LADA in case of low clinical suspicion.

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