Metabolic Characteristics of Recently Diagnosed Adult-onset Autoimmune Diabetes Mellitus.

Metabolic Characteristics of Recently Diagnosed Adult-onset Autoimmune Diabetes Mellitus.

J Clin Endocrinol Metab. 2017 Dec 06;:

Authors: Zaharia OP, Bobrov P, Strassburger K, Bódis K, Karusheva Y, Scholz M, Markgraf DF, Burkart V, Schloot NC, Müssig K, Szendroedi J, Roden M, GDS Group

Abstract
Context and Objective: Among patients diagnosed with type 2 diabetes, autoimmune diabetes often remains undetected. Metabolic features of these patients are insufficiently characterized at present.
Design, Setting and Patients: This study compared age- and sex-matched adult (41-62 years) humans with recent-onset diabetes: patients positive for antibodies against glutamic acid decarboxylase (GAD) and/or cytoplasmic islet-cell antigen with an insulin-free period of >6 months (ab+/ins-; previously termed latent autoimmune diabetes of adults, LADA), type 1 (ab+/ins+), type 2 diabetes (ab-/ins-) and glucose-tolerant humans (controls) of the German Diabetes Study (n=41/group). Beta-cell function was assessed from glucagon tests and intravenous glucose tolerance tests (IVGTT), insulin sensitivity from hyperinsulinemic-euglycemic clamps.
Results: Of the ab+/ins- patients, 33 (81%) were initially diagnosed as type 2 diabetes. In ab+/ins-, body mass index (BMI) was higher than in ab+/ins+ (27.8±5.3 kg/m2 vs 25.0±3.5 kg/m2, p<0.05), lower than in ab-/ins- (31.9±5.8 kg/m2, p<0.05) and similar to controls (29.4±6.6 kg/m2). In ab+/ins-, GAD antibody titers correlated negatively with BMI (r=-0.40, p<0.05) and with C-peptide secretion in glucagon stimulation tests (r=-0.33, p<0.05). Beta-cell function from IVGTT was 228% higher in ab+/ins- than in ab+/ins+, but 35% lower than in ab-/ins- and 61% lower than in controls (all p<0.05). Insulin sensitivity in ab+/ins- was comparable to ab+/ins+ and controls, but 41% higher than in ab-/ins- (p<0.05) after adjustment for BMI and fasting blood glucose or HbA1c.
Conclusion: Even shortly after diagnosis, ab+/ins- patients feature partly preserved beta-cell function and chronic hyperglycemia which possibly contributes to the observed impairment of whole-body insulin sensitivity.

PMID: 29220505 [PubMed - as supplied by publisher]

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