Abstract
Few studies were performed to evaluate the prevalence of latent autoimmune diabetes in adults (LADA) and the difference of chronic complications between LADA, T1DM, and T2DM in Korean. The aim of this study is to establish the prevalence of LADA in a diabetic clinic of Soonchunhyang University hospital and to compare the phenotypic characteristics according to DM classification based on positivity of glutamic acid decarboxylase antibodies (GADA). Also, another important point concerns the occurrence of diabetes chronic microvascular complications in LADA. 323 patients who were checked GADA among diabetic patients admitted at Soonchunhyang University hospital were recruited. Twenty-eight patients (8.7%) were identified as positive for GADA. 11.5% (n = 37) were diagnosed with T1DM and 5.3% (n = 17) were diagnosed with LADA. GADA titer showed significant negative correlation with age of onset, total cholesterol (TC), triglyceride (TG), fasting C-peptide, stimulated C-peptide, BMI, and positive correlation with HbA1C and HDL-C. Compared with those that tested negative for GADA, patients with GADA positive had lower values of onset age, BMI, TC, TG, LDL-C, fasting, and stimulated C-peptide levels and higher values of HbA1C. A significant gradual increase of values was observed for the onset age, BMI, SBP, DBP, fasting, and stimulated C-peptide across the T1DM, LADA, and T2DM subgroups. Concerning the chronic complications there was no difference in prevalence of retinopathy, neuropathy and nephropathy between three groups. Of LADA patients, 12 patients were receiving insulin treatment and mean time to insulin initiation was about 37 months. In conclusion, because our study suggests LADA subgroups in Korea appear to have a faster decline in C-peptide levels, it is worth detecting the patients with LADA early and effort to preserve beta cell function. Furthermore, our results showed that the prevalence of microvascular complication was comparable between the subgroups.
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References
Groop LC, Bottazo GF, Doniach D (1986) Islet cell antibodies identify latent type 1 diabetes in patients aged 35–75 years at diagnosis. Diabetes 35:237–241
Stenstrom G, Gottsater A, Bakhtadze E, Berger B, Sundkvist G (2005) Latent autoimmune diabetes in adults: definition, prevalence, β-cell function, and treatment. Diabetes 54:S68–S72
Turner R, Statton I, Horton V, Manley S, Zimmet P, Mackay IR, Shattock M, Bottazzo GF, Holman R (1997) UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in Type 2 diabetes. UK Prospective Diabetes Study Group. Lancet 350:1288–1293
Zimmet PZ (1995) The pathogenesis and prevention of diabetes in adults: genes, autoimmunity, and demography. Diabetes Care 18:1025–1064
Tuomi T, Carlsson A, Li H, Isomaa B, Miettinen A, Nilsson A, Nissen M, Ehrnstrom BO, Forsen B, Snickars B, Lahti K, Forsblom C, Saloranta C, Taskinen MR, Groop LC (1999) Clinical and genetic characteristics of type 2 diabetes with and without GAD antibodies. Diabetes 48:150–157
Monge L, Bruno G, Pinach S, Grassi G, Maghenzani G, Dani F, Pagano G (2004) A clinically oriented approach increases the efficacy of screening for latent autoimmune diabetes in adults (LADA) in a large clinic-based cohort of patients with diabetes onset over 50 years. Diabet Med 21:456–459
Ruige JB, Batstra MR, Aanstoot HJ, Bouter LM, Bruining GJ, de Neeling JND, Heine RJ (1997) Low prevalence of antibodies to GAD 65 in a 50- to 74-year-old general Dutch population. The Hoorn Study. Diabetes Care 20:1108–1110
Bosi EP, Garancini MP, Poggiali F, Bonifacio E, Gallus G (1999) Low prevalence of islet autoimmunity in adult diabetes and low predictive value of autoantibodies in the general adult population of northern Italy. Diabetologia 42:840–844
Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY (2006) Epidemic obesity and type 2 diabetes in Asia. Lancet 368:1681–1688
Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM (2006) Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey. Diabetes Care 29:226–231
Torn C (2003) C-peptide and autoimmune markers in diabetes. Clin Lab 49:1–10
Borg H, Gottsater A, Fernlund P, Sundkvist G (2002) A 12-year prospective study of the relationship between islet antibodies and β-cell function at and after the diagnosis in patients with adult-onset diabetes. Diabetes 51:1754–1762
Arikan E, Sabuncu T, Ozer EM, Hatemi H (2005) The clinical characteristics of latent autoimmune diabetes in adults and its relation with chronic complications in metabolically poor controlled Turkish patients with Type 2 diabetes mellitus. J Diabetes Complications 19:254–258
Zinman B, Kahn SE, Haffner SM, O’Neill MC, Heise MA, Feed MI (2004) Phenotypic characteristics of GAD antibody-positive recently diagnosed patients with Type 2 diabetes in North America and Europe. Diabetes 53:3193–3200
Lohmann T, Kellner K, Verlohren HJ, Krug J, Steindorf J, Scherbaum WA, Seissler J (2001) Titre and combination of ICA and autoantibodies to glutamic acid decarboxylase discriminate two clinically distinct types of latent autoimmune diabetes in adults (LADA). Diabetologia 44:1005–1010
Davis TM, Zimmet P, Davis WA, Bruce DG, Fida S, Mackay IR (2000) Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multi-ethnic Australian community: the Fremantle Diabetes Study. Diabet Med 17:667–674
Myhill P, Davis WA, Bruce DG, Mackay IR, Zimmet P, Davis TME (2008) Chronic complications and mortality in community-based patients with latent autoimmune diabetes in adults: the Fremantle Diabetes Study. Diabet Med 25:1245–1250
Balme M, McAllister I, Davis WA, Davis TM (2002) Retinopathy in latent autoimmune diabetes of adults: the Fremantle Diabetes Study. Diabet Med 19:602–605
Isomaa B, Almgren P, Henricsson M, Taskinen MR, Tuomi T, Groop L, Sarelin L (1999) Chronic complications in patients with slowly progressing autoimmune Type 1 diabetes (LADA). Diabetes Care 22:1347–1353
Schiel R, Muller UA (2000) GAD autoantibodies in a selection-free population of insulin-treated diabetic patients: indicator of a high prevalence of LADA? Diabetes Res Clin Pract 49:33–40
Kim CS, Park JA, Cho MH, Park JS, Nam JY, Kim DM, Ahn CW, Cha BS, Lim SK, Kim KR, Lee HC (2004) The frequency of Anti-GAD antibody in non-obese, adult-onset type 2 diabetes in Korea and clinical and biological characteristics according to anti-GAD antibody. J Korean Diabetes Assoc 28:66–74
Park YS (2004) The significance of anti-GAD antibodies in lean patients with type 2 diabetes mellitus. Korean Diabetes J 28:63–65
Park Y, Lee H, Koh CS, Min H, Rowley M, Mackay IR, Zimmet P, McCarthy B, McCanlies E, Dorman J, Trucco M (1996) The low prevalence of immunogenetic markers in Korean adult-onset IDDM patients. Diabetes Care 19:241–245
Tsuruoka A, Matsuba I, Toyota T, Isshiki G, Nagataki S, Ikeda Y (1995) Antibodies to GAD in Japanese diabetic patients: a multicenter study. Diabetes Res Clin Pract 28:191–199
Inukai T, Fujiwara Y, Tayama K, Aso Y, Ogino K, Takemura Y (1997) Clinical characteristics of patients with the initial diagnosis of NIDDM with positivity for antibodies to glutamic acid decarboxylase. Exp Clin Endocrinol Diabetes 105:327–330
Lee SA, Kim EY, Kim EH, Jeong JY, Jeong EH, Kim DW, Cho EH, Koh EH, Kim MS, Park JY, Lee KU (2009) Anti-GAD Antibody in patients with adult-onset diabetes in Korea. Korean Diabetes J 33:16–23
Lee SH, Kwon HS, Yoo SJ, Ahn YB, Yoon KU, Cha BY, Lee KW, Son HY (2009) Identifying latent autoimmune diabetes in adults in Korea: the role of C-peptide and metabolic syndrome. Diabetes Res Clin Pract 83:e62–e65
Rosario PW, Reis JS, Amim R, Fagundes TA, Calsolari MR, Silva SC, Purisch S (2005) Comparison of clinical and laboratory characteristics between adult-onset type 1 diabetes and latent autoimmune diabetes in adults. Diabetes Care 28:1803–1804
Hawa MI, Thivolet C, Mauricio D, Alemanno I, Cipponeri E, Collier D, Hunter S, Buzzetti R, de Leiva A, Pozzilli P, Leslie PD (2009) Metabolic syndrome and autoimmune diabetes: action LADA 3. Diabetes Care 32:160–164
Katulanda P, Shine B, Katulanda W, Silva A, Asfir EL, Sheriff R, Somasundaram N, Long AE, Bingley PJ, McCarthy MI, Clark A, Matthews DR (2008) Diabetes mellitus among young adults in Sri Lanka-role of GAD antibodies in classification and treatment: the Sri Lanka Young Diabetes Study. Diabetologia 51:1368–1374
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Roh, MO., Jung, CH., Kim, BY. et al. The prevalence and characteristics of latent autoimmune diabetes in adults (LADA) and its relation with chronic complications in a clinical department of a university hospital in Korea. Acta Diabetol 50, 129–134 (2013). https://doi.org/10.1007/s00592-010-0228-y
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DOI: https://doi.org/10.1007/s00592-010-0228-y