Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype: Action LADA 7
Mohammed I. Hawa,Hubert Kolb,Nanette C. Schloot,Huriya Beyan,Stavroula A Paschou,Raffaella Buzzetti,Didac Mauricio,Alberto de Leiva,Knud Bonnet Yderstræde,Henning Beck-Neilsen,Jaakko Tuomilehto,Cinzia Sarti,Charles Thivolet,David R. Hadden,Steven J. Hunter,Guntram Schernthaner,Werner A. Scherbaum,Rhys Williams,Sinead Brophy,Paolo Pozzilli,Paolo Pozzilli,Richard David Leslie +21 more
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TLDR
The results indicate that adult-onset autoimmune diabetes in Europe encompasses type 1 diabetes and LADA in the same broad clinical and autoantibody-positive spectrum.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 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 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.read more
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UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes
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