Clinical features of slowly progressive type 1 (insulin-dependent) diabetes mellitus: a comparative study based on degree of obesity at diagnosis of diabetes

Abstract

Objective For early differential diagnosis of slowly progressive type 1 diabetes mellitus (SPIDDM) from type 2 diabetes mellitus, we investigated clinical history and characteristics of patients with SPIDDM with or without obesity. Research design and methods Subjects were 39 patients (20 men and 19 women) diagnosed with SPIDDM based on positive antibodies against glutamic acid decarboxylase (GAD) and/or islet-associated antigen 2 (IA-2), with more than 3 months from diabetes mellitus (DM) diagnosis to initiation of insulin therapy, and who were inpatients at our hospital between January 2004 and July 2010. Body mass index (BMI) before DM diagnosis, clinical characteristics at the time of DM diagnosis and SPIDDM diagnosis, and C-peptide levels at the time of DM diagnosis were extracted from medical records. Results The proportion of the patients with maximum BMI C 25 kg/m 2 was 67 % before DM diagnosis, 53 % at the time of DM diagnosis, and 25.6 % at the time of SPIDDM diagnosis, whereas those with BMI \ 22 kg/m 2 were 10.3, 25.0, and 59.0 %, respectively. Compared with patients with BMI\22 kg/m 2 at the time of DM diagnosis, those with BMI C 25 kg/m 2 had a significantly longer period from DM diagnosis to initiation of insulin therapy (p = 0.026); all of these patients had a C-peptide index (CPI) B 1.0 at the time of SPIDDM diagnosis.Conclusion It is proposed that islet-specific autoantibodies should be measured in cases of obese patients with CPI B 1.0 for earlier diagnosis of SPIDDM.

Glutamic Acid Decarboxylase Autoantibody-negative Slowly Progressive Type 1 Diabetes Mellitus: A Case Report and Literature Review

“…On the other hand, patients with LADA or SPT1D who have a lower GADA titer or a smaller number of other islet-related autoantibodies may have a slower decline in endogenous insulin secretion (9,11,12,27), whereas the presence of IAA is a predictor of a rapid decrease in endogenous insulin secretion (15). In the present case, our non-obese GADA-negative patient with single IAA positivity exhibited a short duration from the onset of diabetes mellitus to the initiation of insulin therapy, which was similar to the course of previously reported non-obese Japanese patients with GADA-positive SPT1D (26), and she experienced progression to almost complete insulin deficiency within 2 years after the onset of diabetes mellitus (Table 2B).…”

“…Studies of GADA-positive LADA have revealed that the endogenous insulin secretion in non-obese patients tends to decrease more quickly than that in obese patients (9). A study of GADA-positive Japanese patients with SPT1D also revealed that non-obese patients are likely to exhibit greater decreases in endogenous insulin secretion in comparison to obese patients; they are also likely to have a shorter period between the onset of diabetes mellitus and the initiation of insulin therapy, with a median period of approximately 1.5 years (26). On the other hand, patients with LADA or SPT1D who have a lower GADA titer or a smaller number of other islet-related autoantibodies may have a slower decline in endogenous insulin secretion (9,11,12,27), whereas the presence of IAA is a predictor of a rapid decrease in endogenous insulin secretion (15).…”

Non-insulin-dependent Diabetes Mellitus Induced by Immune Checkpoint Inhibitor Therapy in an Insulinoma-associated Antigen-2 Autoantibody-positive Patient with Advanced Gastric Cancer

“…SPT1D is characterized by a gradual decrease in endogenous insulin secretion, the presence of islet autoantibodies, the absence of DKA at diabetes onset, and clinical features similar to those of T2D. The rate of decrease in insulin secretion varies from case to case, and many patients progress to insulin deficiency within 6 years after diabetes onset (20); however, some patients do not exhibit insulin deficiency even more than 10 years after DM onset because of extremely gradual or no decrease in insulin secretion capacity (22). Most SPT1 D cases are GADA-positive, but GADA-negative/IA-2Abpositive patients have been reported (23,24); these patients tended to exhibit better-preserved insulin secretion than did GADA-positive patients.…”