Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8

Xiaohong Niu; Shuoming Luo; Xia Li; Zhiguo Xie; Yufei Xiang; Gan Huang; Jian Lin; Lin Yang; Zhenqi Liu; Xiangbing Wang; R David Leslie; Zhiguang Zhou

doi:10.1002/dmrr.3068

Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8

Diabetes Metab Res Rev. 2019 Jan;35(1):e3068. doi: 10.1002/dmrr.3068. Epub 2018 Sep 27.

Authors

Xiaohong Niu^{1

2

3}, Shuoming Luo^{1

2}, Xia Li^{1

2}, Zhiguo Xie^{1

2}, Yufei Xiang^{1

2}, Gan Huang^{1

2}, Jian Lin^{1

2}, Lin Yang^{1

2}, Zhenqi Liu⁴, Xiangbing Wang⁵, R David Leslie⁶, Zhiguang Zhou^{1

2}

Affiliations

¹ Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Center for Metabolic Disease, Changsha, China.
³ Department of Endocrinology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
⁵ Division of Endocrinology, Metabolism, and Nutrition, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
⁶ Department of Diabetes and Metabolic Medicine, Blizard Institute, London, UK.

PMID: 30160000
DOI: 10.1002/dmrr.3068

Abstract

Background: Latent autoimmune diabetes in adults (LADA) exhibits significant clinical heterogeneity, but the underlying causes remain unclear. The aim of this study was to investigate whether age of onset of LADA contributes to the observed clinical heterogeneity by comparing the clinical, metabolic, and immunogenetic characteristics between elderly and young LADA patients.

Methods: The cross-sectional study included a total of 579 patients with LADA which was further divided into elderly LADA (E-LADA) group (n = 135, age of onset ≥60 years) and young LADA (Y-LADA) group (n = 444, age of onset <60 years). Age-matched subjects with type 2 diabetes were served as control (E-T2D group, n = 622). Clinical characteristics, serum autoantibodies, and HLA-DQ haplotypes were compared among these groups.

Results: Compared with patients with Y-LADA, patients with E-LADA have better residual beta-cell function and higher level of insulin resistance (both P < .01), more metabolic syndrome characteristics, similar proportion of islet autoantibody positivity, and strikingly different HLA-DQ genetic background. In comparison with E-T2D patients, E-LADA patients tend to have similar metabolic syndrome prevalence, comparable C-peptide levels, and insulin resistance levels and share similar HLA-DQ genetic characteristics.

Conclusions: Elderly LADA differs phenotypically and genetically from Y-LADA but has a clinical and genetic profile more similar to that of E-T2D. These distinct phenotypes could potentially help physicians better manage patients with E-LADA.

Keywords: LADA; class II antigens; clinical characteristics; latent autoimmune diabetes in adults; metabolic syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Autoantibodies / blood
China
Cross-Sectional Studies
Female
Humans
Insulin Resistance / physiology*
Latent Autoimmune Diabetes in Adults / blood
Latent Autoimmune Diabetes in Adults / diagnosis*
Male
Middle Aged
Phenotype*

Substances

Autoantibodies