LADA prevalence estimation and insulin dependency during follow-up.

Abstract

BACKGROUND:

Latent autoimmune diabetes in adults (LADA) is a form of autoimmune-mediated diabetes in adults, usually defined by GAD autoantibody positivity. Few epidemiological surveys on LADA in Asians did not come to a conclusive answer regarding prevalence and incidence, because of different criteria used in patient ascertainment.

METHODS:

We estimated LADA prevalence in a recent type 2 diabetes cohort by the positivity of circulating autoantibodies to pancreatic islet cell antigens (GAD, IA-2 and zinc transporter 8 (ZnT8)) applying a comparable Caucasian criteria. We then observed the development of insulin dependency prospectively for 36 months.

RESULTS:

Applying the European NIRAD LADA group criteria, we found a high prevalence of LADA (4.4%) in Korean patients with phenotypic type 2 diabetes. This high prevalence of LADA in Korea is noteworthy since the previous population-based LADA prevalence survey reported low prevalence (1.7%). When we consider the low-titre GAD antibodies and the low prevalence of multiple autoantibodies, however, increased LADA prevalence does not necessarily mean increase in future insulin dependency. After 36 months of follow-up, only 3 of 39 patients who were initially classified as LADA have become insulin-dependent. Those three were all positive for multiple autoantibodies (GAD, IA-2 and zinc transporter 8 antibody). Other features of insulin secretion or insulin resistance did not determine future insulin necessity.

CONCLUSIONS:

Although the LADA prevalence estimated by anti-GAD positivity appeared to increase, the true insulin dependency evidenced by multiple antibody positivity did not increase in Korea.

• Authors: Yongsoo Park, Sangmo Hong, Leejin Park, Jungtaek Woo, Sehyun Baik, Munsuk Nam, Kwanwoo Lee, Youngseol Kim, KNDP collaboratory Group
• Journal: Diabetes/metabolism research and reviews (Diabetes Metab Res Rev) Vol. 27 Issue 8 Pg. 975-9 (Nov 2011) ISSN: 1520-7560 [Electronic] England
• PMID: 22069296 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 John Wiley & Sons, Ltd.

Chemical References

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

Topics

• Adult
• Aged
• Asian People (statistics & numerical data)
• Autoantibodies (analysis)
• Cation Transport Proteins (immunology)
• Diabetes Mellitus, Type 1 (epidemiology, immunology)
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology, immunology)
• Disease Progression
• Female
• Follow-Up Studies
• Glutamate Decarboxylase (immunology)
• Humans
• Insulin (therapeutic use)
• Insulin Resistance
• Korea (epidemiology)
• Male
• Middle Aged
• Prevalence
• Prospective Studies
• Zinc Transporter 8