Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype Action LADA 7
Por:
Hawa, MI, Kolb, H, Schloot, N, Beyan, H, Paschou, SA, Buzzetti, R, Mauricio, D, de Leiva, A, Yderstraede, K, Beck-Neilsen, H, Tuomilehto, J, Sarti, C, Thivolet, C, Hadden, D, Hunter, S, Schernthaner, G, Scherbaum, WA, Williams, R, Brophy, S, Pozzilli, P, Leslie, RD
Publicada:
1 abr 2013
Resumen:
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. Onlywith screening for autoantibodies, especially GADA, can they be identified with certainty. Diabetes Care 36:908-913, 2013
Filiaciones:
Hawa, MI:
Queen Mary Univ London, Blizard Inst, London, England
Kolb, H:
Univ Dusseldorf, D-40225 Dusseldorf, Germany
Schloot, N:
Univ Dusseldorf, D-40225 Dusseldorf, Germany
Beyan, H:
Queen Mary Univ London, Blizard Inst, London, England
Paschou, SA:
Queen Mary Univ London, Blizard Inst, London, England
Buzzetti, R:
Univ Roma La Sapienza, Rome, Italy
Mauricio, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
de Leiva, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Yderstraede, K:
Odense Univ Hosp, DK-5000 Odense, Denmark
Beck-Neilsen, H:
Odense Univ Hosp, DK-5000 Odense, Denmark
Tuomilehto, J:
Natl Inst Hlth & Welf, Helsinki, Finland
Sarti, C:
Natl Inst Hlth & Welf, Helsinki, Finland
Thivolet, C:
Hosp Edouard Herriot, Lyon, France
Hadden, D:
Royal Victoria Hosp, Belfast BT12 6BA, Antrim, North Ireland
Hunter, S:
Royal Victoria Hosp, Belfast BT12 6BA, Antrim, North Ireland
Schernthaner, G:
Rudolfstiftung Hosp, Vienna, Austria
Scherbaum, WA:
Univ Dusseldorf, D-40225 Dusseldorf, Germany
Williams, R:
Swansea Univ, Swansea, W Glam, Wales
Brophy, S:
Swansea Univ, Swansea, W Glam, Wales
Pozzilli, P:
Queen Mary Univ London, Blizard Inst, London, England
Univ Campus Biomed, Rome, Italy
Leslie, RD:
Queen Mary Univ London, Blizard Inst, London, England
Hybrid Gold, Green Published
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