Latent autoimmune diabetes in adults with low-titer GAD antibodies: similar disease progression with type 2 diabetes: a nationwide, multicenter prospective study (LADA China Study 3).

Abstract

OBJECTIVE:

This study investigated the relationship between GAD autoantibody (GADA) titers and changing of β-cell function in patients with latent autoimmune diabetes in adults (LADA).

RESEARCH DESIGN AND METHODS:

This 3-year prospective study enrolled 95 subjects from 15 Chinese cities including 25 high-titer (GADA ≥180 units/mL) LADA patients, 42 low-titer (GADA <180 units/mL) LADA patients, and 28 type 2 diabetic patients, the latter two groups as controls of similar age, sex, and BMI. Clinical characteristics were determined annually, including glycosylated hemoglobin (HbA1c), fasting C-peptide (FCP), and 2-h postprandial C-peptide (PCP).

RESULTS:

Despite similar initial FCP and PCP, FCP and PCP both decreased more in subjects with high GADA titer (FCP from mean 0.49 nmol/L at entry to 0.13 nmol/L at the third year; P < 0.05) than with low GADA titer (FCP from mean 0.48 to 0.38 nmol/L) and type 2 diabetes (FCP from mean 0.47 to 0.36 nmol/L); the latter two groups being similar. After 3 years, residual β-cell function (FCP >0.2 nmol/L) was detected in only 42% with an initial high GADA titer compared with 90% with a low GADA titer and 97% with type 2 diabetes (P < 0.01 for both). GADA positivity at the third year persisted more in subjects with initially high GADA (92%) than with low GADA (26%) titers (P < 0.01).

CONCLUSIONS:

In selected LADA patients, initial GADA titers identified subjects with different degrees of persistent autoimmunity and disease progression. LADA patients with a low GADA titer had metabolic phenotypes and loss of β-cell function similar to type 2 diabetic patients.

• Authors: Lingjiao Liu, Xia Li, Yufei Xiang, Gan Huang, Jian Lin, Lin Yang, Yunjuan Zhao, Zhifang Yang, Can Hou, Yijun Li, Jie Liu, Dalong Zhu, R David Leslie, Xiangbing Wang, Zhiguang Zhou, LADA China Study Group
• Journal: Diabetes care (Diabetes Care) Vol. 38 Issue 1 Pg. 16-21 (Jan 2015) ISSN: 1935-5548 [Electronic] United States
• PMID: 25336751 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Chemical References

• Autoantibodies
• C-Peptide
• Glycated Hemoglobin A
• Glutamate Decarboxylase

Topics

• Adult
• Autoantibodies (blood, immunology)
• Autoimmune Diseases (immunology)
• Autoimmunity (immunology)
• C-Peptide (blood, metabolism)
• China
• Diabetes Mellitus, Type 2 (immunology)
• Disease Progression
• Fasting
• Female
• Follow-Up Studies
• Glucose Intolerance (immunology)
• Glutamate Decarboxylase (immunology)
• Glycated Hemoglobin (metabolism)
• Humans
• Insulin-Secreting Cells (metabolism)
• Male
• Middle Aged
• Prospective Studies