Relationship between B-cell function and HLA antigens in patients with Type 2 (non-insulin-dependent) diabetes
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In order to study the heterogeneity of Type 2 (non-insulin-dependent) diabetes, we determined HLA antigens and measured B-cell function as C-peptide response to intravenous glucagon in 217 patients with onset of non-ketotic diabetes after the age of 40 years. Their HLA frequencies were compared with those of Type 1 (insulin-dependent) diabetic patients and of healthy blood donors. The Type 1 diabetic patients showed a typical HLA pattern, with increased frequencies of B15, DR3, DR4, B8/B15 and DR3/DR4 and decreased frequencies of 137 and DR2. The Type 2 diabetic patients could be distinguished from blood donors by increased frequencies of Cw4, DR4, DR5 and DR3/DR4, and from Type 1 diabetic patients by increased frequencies of B7, DR2, DR5 and decreased frequency of A9, Bw22 and DR4. Age at onset and body mass index were unrelated to HLA antigens, but the Type 2 diabetic patients with HLA-Cw4, DR5 and DR6 showed a strong family history for Type 2 diabetes. Type 2 diabetic patients with HLA-B8, DR4, B8/B15 and DR3/DR4 showed significantly lower C-peptide concentrations (p < 0.05) than patients without these HLA antigens. In contrast, patients with DR5 and DRw8 presented with high C-peptide levels. Twelve patients who were positive for both DR3 and DR4 and 23 patients who were DR3/DR4 negative were followed with repeated C-peptide determinations during a period of three years. The C-peptide concentrations of the DR3/DR4 positive patients decreased during this period, whereas there was no change in C-peptide levels in the DR3/DR4 negative patients. In conclusion, B-cell function measured as C-peptide response to glucagon correlates with HLA antigens in patients with onset of diabetes after age 40. Impaired B-cell function seems to be associated with Type 1 diabetes-related HLA-antigens, whereas the presence of DR5 was associated with preserved B-cell function and a strong heredity for Type 2 diabetes. The results thus support the concept of heterogeneity in Type 2 diabetes. Admixture of patients with latent Type 1 diabetes can at least partially account for this heterogeneity.
Key wordsType 1 diabetes Type 2 diabetes C-peptide HLA-antigens heredity
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