Metabolic risk profiles in diabetes stratified according to age at onset, islet autoimmunity and fasting C-peptide

Diabetes Res Clin Pract. 2017 Dec;134:62-71. doi: 10.1016/j.diabres.2017.09.014. Epub 2017 Oct 5.

Abstract

Objective: Islet autoimmunity, age at onset and time to insulin treatment are often used to define subgroups of diabetes. However, the latter criterion is not clinical useful. Here, we examined whether an unbiased stratification of diabetes according to age at onset, fasting C-peptide and GAD autoantibodies (GADab) defines groups with differences in glycaemic control and markers of cardiometabolic risk.

Design and methods: A cohort of 4374 adults with relatively newly diagnosed diabetes referred to a Danish hospital during 1997-2012 was stratified according to age at onset above or below 30 years, fasting C-peptide above or below 300 pmol/l (CPEPhigh or CPEPlow), and presence or absence of GADab (GADpos or GADneg). HbA1c, BMI, blood pressure (BP), lipid profile, alanine aminotransferase (ALT) and creatinine were evaluated.

Results: GADab were present in 13% of the cohort. Age at onset was not associated with major differences between groups. Patients with insulin deficient diabetes (CPEPlow; n = 503) had higher HbA1c but otherwise lower cardiometabolic risk (lower BMI, BP, LDL, triacylglycerol, and ALT, and higher HDL) than both patients with latent autoimmune diabetes of adults (LADA defined as GADposCPEPhigh; n = 327) and patients with type 2 diabetes (GADnegCPEPhigh; n = 3544). Patients with LADA defined an intermediate group with higher HbA1c but otherwise lower cardiometabolic risk than patients with type 2 diabetes.

Conclusions: Our results demonstrate that fasting C-peptide and GADab status, but not age at onset, define groups of patients with diabetes with clinically relevant differences in glycaemic control and cardiometabolic risk.

Keywords: Diabetes; Fasting C-peptide; Glycaemic control; Islet autoimmunity; Lipid profile.

MeSH terms

  • Adult
  • Age of Onset
  • Autoimmunity
  • Blood Glucose / metabolism*
  • C-Peptide / blood*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / blood*
  • Fasting
  • Female
  • Humans
  • Islets of Langerhans / immunology*
  • Male
  • Metabolome / immunology*
  • Middle Aged
  • Risk
  • Young Adult

Substances

  • Blood Glucose
  • C-Peptide