LADA and CARDS: a prospective study of clinical outcome in established adult-onset autoimmune diabetes

Mohammed Iqbal Hawa, Ana Paula Buchan, Thomas Ola, Chuan Chuan Wun, David A. DeMicco, Weihang Bao, D. John Betteridge, Paul N. Durrington, John H. Fuller, H. Andrew W. Neil, Helen Colhoun, Richard David Leslie, Graham A. Hitman (Lead / Corresponding author)

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    Abstract

    OBJECTIVE Diabetes-associated autoantibodies can be detected in adult-onset diabetes, even when initially non-insulin requiring, i.e., with latent autoimmune diabetes. We aimed to identify adult-onset autoimmune diabetes in patients with established "type 2 diabetes" participating in the Collaborative Atorvastatin Diabetes Study (CARDS) to characterize their phenotype and clinical outcome. RESEARCH DESIGN AND METHODS We prospectively studied 2,425 European patients with presumed type 2 diabetes (mean age 62 years, diabetes duration 7.9 years) for outcomes at 3.9 years after randomization to either atorvastatin or placebo. Subjects were screened for autoantibodies to GAD (GADA), insulinoma-associated antigen-2 (IA-2A), and zinc-transporter 8 (ZnT8A). RESULTS A total of 173 patients (7.1%) had GADA, ofwhom11 (0.5%) and 5 (0.2%)were also positive for IA-2A and ZnT8A, respectively. At baseline, 44% of GADA-positive patients were not on insulin. Fewer autoantibody-positive than autoantibodynegative patients hadmetabolic syndrome (64 vs. 80%), andmore were on insulin (56 vs. 17%) (P <0.0001 for each) without lower HbA (69 mmol/mol [8.5%] vs. 62 mmol/mol [7.8%]). The frequency of microvascular and macrovascular events was similar in both cohorts, independent of atorvastatin. CONCLUSIONS Adult-onset autoimmune diabetes was prevalent, even in patients with established diabetes presumed to have type 2 diabetes. After 11.8 years' diabetes duration, nearly half the patients with autoimmune diabetes were not on insulin treatment and almost two-thirds had metabolic syndrome. The type of diabetes, whether autoimmune diabetes or type 2 diabetes, did not impact the risk of microvascular disease.
    Original languageEnglish
    Pages (from-to)1643-1649
    Number of pages7
    JournalDiabetes Care
    Volume37
    Issue number6
    DOIs
    Publication statusPublished - 2014

    Keywords

    • Adult
    • Age of Onset
    • Aged
    • Anticholesteremic Agents
    • Autoantibodies
    • Diabetes Mellitus, Type 1
    • Diabetes Mellitus, Type 2
    • Double-Blind Method
    • Female
    • Germany
    • Glucose Intolerance
    • Glutamate Decarboxylase
    • Heptanoic Acids
    • Humans
    • Hypoglycemic Agents
    • Insulin
    • Male
    • Metabolic Syndrome X
    • Middle Aged
    • Phenotype
    • Prevalence
    • Prospective Studies
    • Pyrroles
    • Risk Factors

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  • Cite this

    Hawa, M. I., Buchan, A. P., Ola, T., Wun, C. C., DeMicco, D. A., Bao, W., Betteridge, D. J., Durrington, P. N., Fuller, J. H., Neil, H. A. W., Colhoun, H., Leslie, R. D., & Hitman, G. A. (2014). LADA and CARDS: a prospective study of clinical outcome in established adult-onset autoimmune diabetes. Diabetes Care, 37(6), 1643-1649. https://doi.org/10.2337/dc13-2383