Adult-onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: Action LADA 7.

Abstract

OBJECTIVE:

Specific autoantibodies characterize type 1 diabetes in childhood but are also found in adult-onset diabetes, even when initially non-insulin requiring, e.g., with latent autoimmune diabetes (LADA). We aimed to characterize adult-onset autoimmune diabetes.

RESEARCH DESIGN AND METHODS:

We consecutively studied 6,156 European diabetic patients attending clinics within 5 years of diagnosis (age range, 30-70 years) examined cross-sectionally clinically and for GAD antibodies (GADA) and antibodies to insulinoma-associated antigen-2 (IA-2A) and zinc-transporter 8 (ZnT8A).

RESULTS:

Of 6,156 patients, 541 (8.8%) had GADA and only 57 (0.9%) IA-2A or ZnT8A alone. More autoantibody-positive than autoantibody-negative patients were younger, leaner, on insulin (49.5 vs. 13.2%), and female (P < 0.0001 for each), though LADA patients (9.7% of total) did not show categorically distinct clinical features from autoantibody-negative type 2 diabetes. Similarly, more GADA patients with high (>200 World Health Organization IU) (n = 403) compared with low (n = 138) titer were female, lean, and insulin treated (54.6 vs. 39.7%) (P < 0.02 for each). Autoantibody-positive patients usually had GADA (541 of 598; 90.5%) and had LADA more often than type 1 autoimmune diabetes (odds ratio 3.3).

CONCLUSIONS:

Adult-onset autoimmune diabetes emerges as a prevalent form of autoimmune diabetes. Our results indicate that adult-onset autoimmune diabetes in Europe encompasses type 1 diabetes and LADA in the same broad clinical and autoantibody-positive spectrum. At diagnosis, patients with adult-onset autoimmune diabetes are usually non-insulin requiring and clinically indistinguishable from patients with type 2 diabetes, though they tend to be younger and leaner. Only with screening for autoantibodies, especially GADA, can they be identified with certainty.

• Authors: Mohammed I Hawa, Hubert Kolb, Nanette Schloot, Huriya Beyan, Stavroula A Paschou, Raffaella Buzzetti, Didac Mauricio, Alberto De Leiva, Knud Yderstraede, Henning Beck-Neilsen, Jaakko Tuomilehto, Cinzia Sarti, Charles Thivolet, David Hadden, Steven Hunter, Guntram Schernthaner, Werner A Scherbaum, Rhys Williams, Sinead Brophy, Paolo Pozzilli, Richard David Leslie, Action LADA consortium
• Journal: Diabetes care (Diabetes Care) Vol. 36 Issue 4 Pg. 908-13 (Apr 2013) ISSN: 1935-5548 [Electronic] United States
• PMID: 23248199 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Autoantibodies
• Cation Transport Proteins
• ICA512 autoantibody
• SLC30A8 protein, human
• Zinc Transporter 8

Topics

• Adult
• Aged
• Autoantibodies (immunology)
• Cation Transport Proteins (immunology)
• Cross-Sectional Studies
• Diabetes Mellitus, Type 1 (epidemiology, immunology)
• Europe (epidemiology)
• Female
• Humans
• Male
• Middle Aged
• Prevalence
• Zinc Transporter 8