LADA prevalence estimation and insulin dependency during follow-up

Diabetes Metab Res Rev. 2011 Nov;27(8):975-9. doi: 10.1002/dmrr.1278.

Abstract

Background: Latent autoimmune diabetes in adults (LADA) is a form of autoimmune-mediated diabetes in adults, usually defined by GAD autoantibody positivity. Few epidemiological surveys on LADA in Asians did not come to a conclusive answer regarding prevalence and incidence, because of different criteria used in patient ascertainment.

Methods: We estimated LADA prevalence in a recent type 2 diabetes cohort by the positivity of circulating autoantibodies to pancreatic islet cell antigens (GAD, IA-2 and zinc transporter 8 (ZnT8)) applying a comparable Caucasian criteria. We then observed the development of insulin dependency prospectively for 36 months.

Results: Applying the European NIRAD LADA group criteria, we found a high prevalence of LADA (4.4%) in Korean patients with phenotypic type 2 diabetes. This high prevalence of LADA in Korea is noteworthy since the previous population-based LADA prevalence survey reported low prevalence (1.7%). When we consider the low-titre GAD antibodies and the low prevalence of multiple autoantibodies, however, increased LADA prevalence does not necessarily mean increase in future insulin dependency. After 36 months of follow-up, only 3 of 39 patients who were initially classified as LADA have become insulin-dependent. Those three were all positive for multiple autoantibodies (GAD, IA-2 and zinc transporter 8 antibody). Other features of insulin secretion or insulin resistance did not determine future insulin necessity.

Conclusions: Although the LADA prevalence estimated by anti-GAD positivity appeared to increase, the true insulin dependency evidenced by multiple antibody positivity did not increase in Korea.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asian Continental Ancestry Group / statistics & numerical data
  • Autoantibodies / analysis
  • Cation Transport Proteins / immunology
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / immunology*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / immunology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glutamate Decarboxylase / immunology
  • Humans
  • Insulin / therapeutic use
  • Insulin Resistance
  • Korea / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Zinc Transporter 8

Substances

  • Autoantibodies
  • Cation Transport Proteins
  • ICA512 autoantibody
  • Insulin
  • SLC30A8 protein, human
  • Zinc Transporter 8
  • Glutamate Decarboxylase