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

Research output: Contribution to journalArticlepeer-review

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. © 2014 by the American Diabetes Association.
Original languageEnglish
Pages (from-to)1643-1649
Number of pages7
JournalDiabetes Care
Volume37
Issue number6
DOIs
Publication statusPublished - Jun 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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