A large European cross-sectional study showed that nearly 10% of adults with onset diabetes have diabetes-related autoantibodies. The study was published online in Diabetes Care on December 17, 2012.
Many autoimmune diabetic patients do not require insulin therapy at the time of diagnosis, and, although they tend to be younger and thinner, they generally do not show clinically significant differences from autoantibody-negative type 2 diabetic patients.
"Only screening autoantibodies, especially glutamate decarboxylase autoantibodies (GADA), can clearly identify these patients." Dr. Mohammed I. Hawa, Ph.D., and colleagues at the Blizard Research Institute at Queen Mary University of London in London and colleagues wrote.
The study included 6156 patients who were diagnosed with diabetes for less than 5 years (mean 2.2 years) and were 30 to 70 years old (mean 54.4 years). The majority (84.6%) are white, and men account for 58.5%. These patients were recruited from primary care centers, communities or hospitals in nine European countries from 2004 to 2007 to participate in adult latent autoimmune diabetes (LADA) action research.
In the entire patient population, 9.7% of patients have at least one diabetes-related autoantibody, including 8.8% with GADA, 2.3% with insulinoma-associated antigen-2 autoantibody, and 1.8% with zinc transporter 8 autoantibody.
Of the 598 patients with autoantibodies, nearly 1/4 (24.1%) had more than one different autoantibodies, and 90.5% were GADA positive.
"These observations show that adult-onset autoimmune diabetes is not uncommon." The authors point out.
"Clinically, information about GADA in adult-onset diabetes patients reminds physicians that the possibility of progressing faster to insulin therapy increases."
During the study period, 49.5% of autoantibody-positive patients were treated with insulin, compared with 13.2% of autoantibody-negative patients (P <0.001).
Of the 279 autoantibody-positive patients who received insulin therapy, 203 patients had precise information about when they started insulin therapy. Of these 203 patients, 56.2% were determined to have type 1 diabetes (positive for autoantibodies and started treatment with insulin at the time of diagnosis).
Another 32.0% of patients were classified as having the LADA group (autoantibodies were positive, but they were not treated with insulin for at least 6 months after diagnosis). The third group accounted for the remaining 11.8%, which was between the first two groups (positive autoantibodies, insulin therapy started within 1 to 6 months after diagnosis).
Compared with the LADA group, patients with typical type 1 diabetes were younger, and the age at onset, body mass index, waist circumference, and waist-to-hip ratio were all smaller (all P values ​​<0.001).
In the entire study population, the prevalence of LADA was more than three times the prevalence of typical autoimmune type 1 diabetes (377 patients vs 114 patients), with a odds ratio of 3.3.
Other analyses have shown that although patients with higher GADA titers are more similar to patients with type 1 diabetes (younger, leaner, receiving insulin therapy, etc.) than those with lower GADA levels, "but in various Each type of autoimmune diabetes can be seen in the GADA titer range. "Dr. Hawa and colleagues pointed out.
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