nach oben

Erschienen in:

01.08.2008 | Article

Diabetes mellitus among young adults in Sri Lanka—role of GAD antibodies in classification and treatment: The Sri Lanka Young Diabetes study

verfasst von: P. Katulanda, B. Shine, G. W. Katulanda, A. Silva, E. L. Asfir, R. Sheriff, N. Somasundaram, A. E. Long, P. J. Bingley, M. I. McCarthy, A. Clark, D. R. Matthews

Erschienen in: Diabetologia | Ausgabe 8/2008

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

Diabetes mellitus is increasing among young adult South Asians. The aim of this study was to determine the prevalence and phenotypic characteristics of diabetes subtypes based on GAD65 autoantibody (GADA) status in those with young adult-onset diabetes in Sri Lanka.

Methods

Clinical, metabolic and GADA data were available for 992 consecutively recruited individuals with diabetes aged ≤45 years (age at diagnosis 16–40 years). Participants were classified according to the following definitions: type 1 diabetes, insulin-dependent <6 months from diagnosis; latent autoimmune diabetes in adults (LADA), GADA-positive, age ≥30 years and insulin-independent ≥6 months from diagnosis; type 2 diabetes, GADA-negative and insulin-independent ≥6 months from diagnosis.

Results

The median (interquartile range) age at diagnosis and diabetes duration were 33.0 (29.0–36.1) and 4.0 (1.1–7.1) years, respectively; 42.1% were male. GADA positivity was seen in 5.4% of participants (n = 54) and GADA levels negatively correlated with age at diagnosis (p < 0.0001), BMI (p < 0.0001) and time to insulin requirement (p = 0.006). Type 1 diabetes, type 2 diabetes and LADA were present in 7.0%, 89.7% and 2.6%, respectively. The remaining 0.7% of the participants were GADA-positive, insulin independent ≥6 months from diagnosis and were diagnosed at age <30 years. The metabolic syndrome and homeostasis model assessment of beta cell function (HOMA %B) were lowest in GADA-positive type 1 diabetes and increased progressively in latent autoimmune diabetes, GADA-negative type 1 diabetes and type 2 diabetes. Among those requiring insulin, 69.2% had fasting C-peptide levels in the lowest quartile, whereas only 19.5% were GADA-positive (p < 0.0001).

Conclusions/interpretation

The prevalence of GADA-positive autoimmune diabetes is low among individuals with young adult-onset diabetes in Sri Lanka. Young-onset diabetic phenotypes appear as a continuum from autoimmune type 1 diabetes to type 2 diabetes.

Nur mit Berechtigung zugänglich

Alberti G, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M (2004) Type 2 diabetes in the young: the evolving epidemic: the International Diabetes Federation consensus workshop. Diabetes Care 27:1798–1811PubMedCrossRef

Chan JC, Ng MC (2003) Lessons learned from young-onset diabetes in China. Curr Diab Rep 3:101–107PubMedCrossRef

Owen KR, Shepherd M, Stride A, Ellard S, Hattersley AT (2002) Heterogeneity in young adult onset diabetes: aetiology alters clinical characteristics. Diabet Med 19:758–761PubMedCrossRef

Katulanda P, Sheriff MH, Matthews DR (2006) The diabetes epidemic in Sri Lanka—a growing problem. Ceylon Med J 51:26–28PubMed

Mohan V, Deepa M, Deepa R et al (2006) Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India—the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 49:1175–1178PubMedCrossRef

Ramachandran A, Snehalatha C, Baskar AD et al (2004) Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia 47:860–865PubMedCrossRef

American Diabetes Association (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(Suppl 1):S5–S20

Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553PubMedCrossRef

Groop LC, Bottazzo GF, Doniach D (1986) Islet cell antibodies identify latent type I diabetes in patients aged 35–75 years at diagnosis. Diabetes 35:237–241PubMedCrossRef

10.

Tuomi T, Groop LC, Zimmet PZ, Rowley MJ, Knowles W, Mackay IR (1993) Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes mellitus in adults with a non-insulin-dependent onset of disease. Diabetes 42:359–362PubMedCrossRef

11.

Zimmet PZ, Tuomi T, Mackay IR et al (1994) Latent autoimmune diabetes mellitus in adults (LADA): the role of antibodies to glutamic acid decarboxylase in diagnosis and prediction of insulin dependency. Diabet Med 11:299–303PubMedCrossRef

12.

Palmer JP, Hampe CS, Chiu H, Goel A, Brooks-Worrell BM (2005) Is latent autoimmune diabetes in adults distinct from type 1 diabetes or just type 1 diabetes at an older age? Diabetes 54(Suppl 2):S62–S67PubMedCrossRef

13.

Lohmann T, Nietzschmann U, Kiess W (2000) ‘Lady-like’: is there a latent autoimmune diabetes in the young? Diabetes Care 23:1707–1708PubMedCrossRef

14.

Turner R, Stratton I, Horton V et al (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 350:1288–1293PubMedCrossRef

15.

Pan CY, So WY, Khalid BA et al (2004) Metabolic, immunological and clinical characteristics in newly diagnosed Asian diabetes patients aged 12–40 years. Diabet Med 21:1007–1013PubMedCrossRef

16.

Tica V, Hanif MW, Andersson A et al (2003) Frequency of latent autoimmune diabetes in adults in Asian patients diagnosed as type 2 diabetes in Birmingham, United Kingdom. Ann N Y Acad Sci 1005:356–358PubMedCrossRef

17.

Britten AC, Jones K, Torn C et al (2007) Latent autoimmune diabetes in adults in a South Asian population of the U.K. Diabetes Care 30:3088–3090PubMedCrossRef

18.

Sahu RP, Aggarwal A, Zaidi G et al (2007) Etiology of early-onset type 2 diabetes in Indians: islet autoimmunity and mutations in hepatocyte nuclear factor 1alpha and mitochondrial gene. J Clin Endocrinol Metab 92:2462–2467PubMedCrossRef

19.

WHO (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854:1–452

20.

Trinder P (1969) Determination of blood glucose using 4-amino phenazone as oxygen acceptor. J Clin Pathol 22:246PubMedCrossRef

21.

Warnick GR, Knopp RH, Fitzpatrick V, Branson L (1990) Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints. Clin Chem 36:15–19PubMed

22.

Moridani MY, Verjee Z, Allen LC (2003) Analytical evaluation of hemoglobin A(1c) dual kit assay on Bio-Rad Variant II: an automated HPLC hemoglobin analyzer for the management of diabetic patients. Clin Biochem 36:317–320PubMedCrossRef

23.

Bingley PJ, Bonifacio E, Williams AJ, Genovese S, Bottazzo GF, Gale EA (1997) Prediction of IDDM in the general population: strategies based on combinations of autoantibody markers. Diabetes 46:1701–1710PubMedCrossRef

24.

Bingley PJ, Bonifacio E, Mueller PW (2003) Diabetes antibody standardization program: first assay proficiency evaluation. Diabetes 52:1128–1136PubMedCrossRef

25.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRef

26.

Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome—a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med 23:469–480PubMedCrossRef

27.

Hermitte L, Atlan-Gepner C, Mattei C et al (1998) Diverging evolution of anti-GAD and anti-IA-2 antibodies in long-standing diabetes mellitus as a function of age at onset: no association with complications. Diabet Med 15:586–591PubMedCrossRef

28.

Borg H, Gottsater A, Fernlund P, Sundkvist G (2002) A 12-year prospective study of the relationship between islet antibodies and beta-cell function at and after the diagnosis in patients with adult-onset diabetes. Diabetes 51:1754–1762PubMedCrossRef

29.

Desai M, Cull CA, Horton VA et al (2007) GAD autoantibodies and epitope reactivities persist after diagnosis in latent autoimmune diabetes in adults but do not predict disease progression: UKPDS 77. Diabetologia 50:2052–2060PubMedCrossRef

30.

Kanungo A, Sanjeevi CB (2003) IA-2 autoantibodies are predominant in latent autoimmune diabetes in adults patients from eastern India. Ann N Y Acad Sci 1005:390–394PubMedCrossRef

31.

Tuomi T, Carlsson A, Li H et al (1999) Clinical and genetic characteristics of type 2 diabetes with and without GAD antibodies. Diabetes 48:150–157PubMedCrossRef

32.

Thai AC, Ng WY, Loke KY, Lee WR, Lui KF, Cheah JS (1997) Anti-GAD antibodies in Chinese patients with youth and adult-onset IDDM and NIDDM. Diabetologia 40:1425–1430PubMedCrossRef

33.

Maioli M, Alejandro E, Tonolo G et al (2004) Epitope-restricted 65-kilodalton glutamic acid decarboxylase autoantibodies among new-onset Sardinian type 2 diabetes patients define phenotypes of autoimmune diabetes. J Clin Endocrinol Metab 89:5675–5682PubMedCrossRef

34.

Zinman B, Kahn SE, Haffner SM, O, Neill MC, Heise MA, Freed MI (2004) Phenotypic characteristics of GAD antibody-positive recently diagnosed patients with type 2 diabetes in North America and Europe. Diabetes 53:3193–3200PubMedCrossRef

35.

Barnett AH, Dixon AN, Bellary S et al (2006) Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia 49:2234–2246PubMedCrossRef

36.

Odugbesan O, Fletcher J, Mijovic C, Mackay E, Bradwell AR, Barnett AH (1987) The HLA-D associations of type 1 (insulin-dependent) diabetes in Punjabi Asians in the United Kingdom. Diabetologia 30:618–621PubMed

37.

Rosario PW, Reis JS, Amim R et al (2005) Comparison of clinical and laboratory characteristics between adult-onset type 1 diabetes and latent autoimmune diabetes in adults. Diabetes Care 28:1803–1804PubMedCrossRef

38.

Kyvik KO, Nystrom L, Gorus F et al (2004) The epidemiology of type 1 diabetes mellitus is not the same in young adults as in children. Diabetologia 47:377–384PubMedCrossRef

39.

Singh AK, Bhatia E, Dabadghao P, Bhatia V, Gellert SA, Colman PG (2000) Role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indians. Diabet Med 17:275–280PubMedCrossRef

40.

Panz VR, Kalk WJ, Zouvanis M, Joffe BI (2000) Distribution of autoantibodies to glutamic acid decarboxylase across the spectrum of diabetes mellitus seen in South Africa. Diabet Med 17:524–527PubMedCrossRef

41.

Ohta M, Obayashi H, Takahashi K et al (1996) Radioimmunoprecipitation assay for glutamic acid decarboxylase antibodies evaluated clinically with sera from patients with insulin-dependent diabetes mellitus. Clin Chem 42:1975–1978PubMed

42.

Vandewalle CL, Falorni A, Svanholm S, Lernmark A, Pipeleers DG, Gorus FK (1995) High diagnostic sensitivity of glutamate decarboxylase autoantibodies in insulin-dependent diabetes mellitus with clinical onset between age 20 and 40 years. The Belgian Diabetes Registry. J Clin Endocrinol Metab 80:846–851PubMedCrossRef

43.

Blohme G, Nystrom L, Arnqvist HJ et al (1992) Male predominance of type 1 (insulin-dependent) diabetes mellitus in young adults: results from a 5-year prospective nationwide study of the 15–34-year age group in Sweden. Diabetologia 35:56–62PubMedCrossRef

44.

Gale EA, Gillespie KM (2001) Diabetes and gender. Diabetologia 44:3–15PubMedCrossRef

45.

Goswami R, Kochupillai N, Gupta N, Kukreja A, Lan M, Maclaren NK (2001) Islet cell autoimmunity in youth onset diabetes mellitus in Northern India. Diabetes Res Clin Pract 53:47–54PubMedCrossRef

46.

Zargar AH, Bhat MH, Laway BA, Masoodi SR (2001) Clinical and aetiological profile of early onset diabetes mellitus: data from a tertiary care centre in the Indian subcontinent. J Postgrad Med 47:27–29PubMed

47.

Gale EA (2005) Latent autoimmune diabetes in adults: a guide for the perplexed. Diabetologia 48:2195–2199PubMedCrossRef

48.

Leslie RD, Williams R, Pozzilli P (2006) Clinical review: type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab 91:1654–1659PubMedCrossRef

49.

Cervin C, Lyssenko V, Bakhtadze E et al (2008) Genetic similarities between latent autoimmune diabetes in adults, type 1 diabetes, and type 2 diabetes. Diabetes 57:1433–1437PubMedCrossRef

50.

Alberti KG, Zimmet P, Shaw J (2007) International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med 24:451–463PubMedCrossRef

Titel: Diabetes mellitus among young adults in Sri Lanka—role of GAD antibodies in classification and treatment: The Sri Lanka Young Diabetes study
verfasst von: P. Katulanda
B. Shine
G. W. Katulanda
A. Silva
E. L. Asfir
R. Sheriff
N. Somasundaram
A. E. Long
P. J. Bingley
M. I. McCarthy
A. Clark
D. R. Matthews
Publikationsdatum: 01.08.2008
Verlag: Springer-Verlag
Erschienen in: Diabetologia / Ausgabe 8/2008
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-008-1052-6

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Diabetes mellitus among young adults in Sri Lanka—role of GAD antibodies in classification and treatment: The Sri Lanka Young Diabetes study

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin

Springer Medizin

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2008

Reduced cardiorespiratory fitness, low physical activity and an urban environment are independently associated with increased cardiovascular risk in children

Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial

Functional significance of repressor element 1 silencing transcription factor (REST) target genes in pancreatic beta cells

Hypermethylation of hepatic Gck promoter in ageing rats contributes to diabetogenic potential

The effect of birthweight upon insulin resistance and associated cardiovascular risk factors in adolescence is not explained by fetal growth velocity in the third trimester as measured by repeated ultrasound fetometry

Integrity of cerebral white matter in type 1 diabetes

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin