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

TY - JOUR

T1 - LADA and CARDS

T2 - a prospective study of clinical outcome in established adult-onset autoimmune diabetes

AU - Hawa, Mohammed Iqbal

AU - Buchan, Ana Paula

AU - Ola, Thomas

AU - Wun, Chuan Chuan

AU - DeMicco, David A.

AU - Bao, Weihang

AU - Betteridge, D. John

AU - Durrington, Paul N.

AU - Fuller, John H.

AU - Neil, H. Andrew W.

AU - Colhoun, Helen

AU - Leslie, Richard David

AU - Hitman, Graham A.

N1 - © 2014 by the American Diabetes Association.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Adult

KW - Age of Onset

KW - Aged

KW - Anticholesteremic Agents

KW - Autoantibodies

KW - Diabetes Mellitus, Type 1

KW - Diabetes Mellitus, Type 2

KW - Double-Blind Method

KW - Female

KW - Germany

KW - Glucose Intolerance

KW - Glutamate Decarboxylase

KW - Heptanoic Acids

KW - Humans

KW - Hypoglycemic Agents

KW - Insulin

KW - Male

KW - Metabolic Syndrome X

KW - Middle Aged

KW - Phenotype

KW - Prevalence

KW - Prospective Studies

KW - Pyrroles

KW - Risk Factors

UR - https://www.scopus.com/pages/publications/84901421772

U2 - 10.2337/dc13-2383

DO - 10.2337/dc13-2383

M3 - Article

C2 - 24722498

AN - SCOPUS:84901421772

SN - 0149-5992

VL - 37

SP - 1643

EP - 1649

JO - Diabetes Care

JF - Diabetes Care

IS - 6

ER -