Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8

Niu, Xiaofeng; Luo, Shuoming; Li, Xia; Xie, Zhiguo; Xiang, Yufei; Huang, Gan; Lin, Jian; Yang, Lin; Liu, Zhenqi; Leslie, Richard; Zhang, Zhou

doi:10.1002/dmrr.3068

Cited by 21 publications

(29 citation statements)

References 31 publications

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“…Although metabolic syndrome has been described in LADA patients, obesity, dyslipidaemia and hypertension are less frequent in LADA patients than in T2D patients . Prior suggestions that LADA and T2D patients might be at similar risk of CV events implied that there might have been a different impact of the traditional CV risk factors in LADA patients.…”

Section: Discussionsupporting

confidence: 68%

“…Although metabolic syndrome has been described in LADA patients, obesity, dyslipidaemia and hypertension are less frequent in LADA patients than in T2D patients. [25][26][27] Prior suggestions that LADA and T2D patients might be at similar risk of CV events implied that F I G U R E 2 Post-hoc Cox regression analysis of LADA and T2D participants in the UKPDS with respect to MACE and CV death at the end of the trial and at the end of the trial plus post-trial monitoring period. Abbreviations: CV, cardiovascular; LADA, latent autoimmune diabetes of adults; MACE, major adverse cardiovascular events; Met, metformin; SU, sulphonylurea, T2D, type 2 diabetes there might have been a different impact of the traditional CV risk factors in LADA patients.…”

Section: Effect Of Assigned Glycaemic Strategy On CV Outcomes By Lamentioning

confidence: 99%

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Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Maddaloni

Coleman

Pozzilli

et al. 2019

Diabetes Obesity Metabolism

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Aims: Latent autoimmune diabetes in adults (LADA) is diagnosed in up to 12% of adults with clinically diagnosed type 2 diabetes (T2D). LADA tends to have healthier cardiovascular (CV) risk profiles than T2D, but it remains uncertain whether the risk of CV events differs between the two. We examined the risk of CV events in patients enrolled in the United Kingdom Prospective Diabetes Study (UKPDS) according to LADA status. Materials and methods: Diabetes autoantibodies (AAb) were measured in 5062 UKPDS participants. The incidence of major adverse CV events (MACE), defined as CV death, non-fatal myocardial infarction or non-fatal stroke, was compared in those with LADA (≥1 AAb test positive) and those without LADA (AAb negative). Results: There were 567 participants (11.2%) with LADA. Compared with participants with T2D, they were younger, with higher mean HbA1c and HDL-cholesterol values, and with lower body mass index and total cholesterol and systolic blood pressure values (all P < 0.01). After a median (25th, 75th percentile) 17.3 (12.6-20.7) years of follow-up, MACE occurred in 157 (17.4 per 1000 person-years) participants with LADA and in 1544 (23.5 per 1000 person-years) participants with T2D (HR, 0.73; 95% confidence interval [CI], 0.62-0.86; P < 0.001). However, after adjustment for confounders, this difference was no longer significant (HR adj , 0.90; 95% CI, 0.76-1.07; P = 0.22).Conclusions: In adults thought to have newly diagnosed T2D, the long-term risk of MACE was lower in those with LADA. However, this did not differ after adjustment for traditional CV risk factors, suggesting that measurement of AAb in addition to traditional CV risk factors will not aid in stratification of CV risk in clinically diagnosed T2D.

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Section: Discussionsupporting

confidence: 68%

Section: Effect Of Assigned Glycaemic Strategy On CV Outcomes By Lamentioning

confidence: 99%

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Maddaloni

Coleman

Pozzilli

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Those LADA patients were separated in two groups in accordance with the onset of diabetes over or under 60 years of age, LADA‐Elderly, and LADA‐Young, respectively. LADA‐E compared with LADA‐Y had better residual β‐cell function, higher insulin resistance, more serious metabolic syndrome characteristics, similar proportion of islet autoantibody positivity, and, strikingly, different HLA‐DQ genetic background …”

Section: Discussionmentioning

confidence: 97%

Immunological and clinical characteristics of latent autoimmune diabetes in the elderly

Yohena

Steinhardt

Müller³

et al. 2019

Diabetes Metabolism Res

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Background: Latent autoimmune diabetes in adults (LADA) is determined by both a noninsulin-dependent clinical presentation and an autoimmune pathogenic process. Glutamic acid decarboxylase antibody (GADA) constitutes the most important marker, although IA-2A and ZnT8A also define LADA presentation. Type 2 diabetes mellitus (T2DM) is the most prevalent type particularly over 65 years old. Studies about autoimmunity in this age group are scarce. Objective: The aim of this work was to determine whether three autoantibodies for diabetes autoimmunity were present in elderly T2DM patients, and to assess the distinctive clinical features of autoantibody-positive patients. Research Design and Methods: We recruited 153 patients with diabetes with onset of diabetes after 65 years of age and a BMI under 30 kg/m 2 .Results: The prevalence of at least one of the autoantibodies was 15.68% (24/153). The most prevalent autoantibody was GADA with 8.49% (13/153), followed by ZnT8A with 6.50% (10/153) and IA2A with 1.96% (3/153). The autoimmunity-positive group presented higher HbA1c (7.01 ± 1.98 vs 6.35 ± 1.01; P = 0.007) and more prevalent insulin therapy (25% vs 10.85%; P = 0.047). GADApositive patients with diabetes presented higher FPG (7.79 ± 3.79 mmol/L vs 6.43 ± 1.6 mmol/L; P = 0.014) and insulin therapy more frequently (46% vs 10.71%; p = 0.015). GADA titre levels in the individuals with BMI under 27 kg/m 2 were higher (35.00 ± 4.20) than those in the group with BMI over 27 kg/m 2 (8.83 ± 3.041; P = 0.0005).Conclusion: Autoantibodies GADA and Znt8A may be useful markers in identifying a subgroup of older patients with a clinical presentation of diabetes which could be characterized as latent autoimmune diabetes in the elderly.

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“…However, there are abundant variations in the genotypes and the prevalence of islet autoantibodies in T1D patients across different races. Our previous study indicated that the age of onset contributes to the clinical heterogeneity in slow‐onset patients with T1D . It also has been shown that the level of C‐peptide at diagnosis is independently associated with the age of onset but also with HLA genotypes .…”

Section: Introductionmentioning

confidence: 96%

Distinct two different ages associated with clinical profiles of acute onset type 1 diabetes in Chinese patients

Luo

Huang

et al. 2019

Diabetes Metabolism Res

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Background: There are abundant variations in the phenotypes and genetics of type 1 diabetes (T1D) patients across different races. This study aimed to assess differences between juvenile acute onset (JAO) and adult acute onset in Chinese T1D patients. Methods:Seven hundred and fifty-one acute onset T1D patients were divided into two groups by the patient onset age as follows: the juvenile acute onset group (≤20 years, JAO group) and the adult acute onset group (>20 years, AAO group). Clinical characteristics, islet autoantibodies, and HLA class II haplotypes and genotypes were compared between these two groups. Results:In comparison with AAO patients, JAO patients had significantly lower relative weights and lower triglyceride levels (P < .001, P < .01, respectively) but higher frequency of ketoacidosis (P < .001), higher daily insulin dosage (P c < .001), higher HbA1 c (P c < .05), and higher HDL-cholesterol levels (P c < .01). The JAO group showed a higher prevalence of IA-2A, ZnT8A, and multiple autoantibodies than that in the AAO group (P < .001, P < .01, P < .001, respectively). Haplotypes for DRB1*0301-DQA1*03-DQB1*0201, DR3, DR4, DR9, and DR3/DR9 genotypes are highly associated with JAO susceptibility, whereas only DR3 and DR9 genotypes confer risk for AAO. In the JAO group but not the AAO group, DR3 is related to ZnT8A, and DR3/DR9 is related to IA-2A and multiple autoantibodies.Conclusions: These observations suggest that JAO patients markedly differ from AAO patients in their clinical manifestations and genetics in the Chinese T1D population. Notably, the DR3/DR9 genotype can facilitate the appearance of IA-2A or multiple autoantibodies in JAO patients.

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Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8

Abstract: Elderly LADA differs phenotypically and genetically from Y-LADA but has a clinical and genetic profile more similar to that of E-T2D. These distinct phenotypes could potentially help physicians better manage patients with E-LADA.

Cited by 21 publications

References 31 publications

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Immunological and clinical characteristics of latent autoimmune diabetes in the elderly

Distinct two different ages associated with clinical profiles of acute onset type 1 diabetes in Chinese patients

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