Clinical, Genetic and Metabolic Characterisation of LADA (Latent Autoimmune Diabetes in Adults)

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Latent autoimmune diabetes in adults (LADA) comprises about 10% of patients initially diagnosed with type 2 diabetes but who are positive for pancreatic islet antibodies, especially to glutamic acid decarboxylase (GADabs). The present studies focused on clinical, genetic and metabolic characterisation of patients with LADA. In LADA, the frequency of the type 1 diabetes susceptibility genotype HLA-DQB1*0201/*0302 and genotypes including the 0302 allele was higher than in type 2 diabetes but lower than in type 1 diabetes. No difference was seen between LADA and type 2 diabetic or control subjects regarding the frequency of the insulin gene alleles associated with the risk of type 1 diabetes, whereas the frequency of these alleles was high in type 1 diabetic patients. In the LADA subjects, beta-cell function was significantly impaired at diagnosis compared with type 2 diabetic patients, but was markedly better preserved compared with age-matched adult type 1 diabetic patients. GADab positivity was linked with decreased insulin secretion in non-diabetic subjects, suggesting that GADabs are markers of beta-cell autoimmunity, although this does not always lead to overt diabetes. Features of the metabolic syndrome in LADA were fewer than in type 2 diabetes but more common than in type 1 diabetes. The results show that although LADA shares characteristics with both type 1 and type 2 diabetes it can be clinically, genetically, and metabolically distinguished from both types. The distinction is of clinical importance for identifying LADA and to achieve proper care of these patients.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Department of Clinical Sciences, Malmö
Supervisors/Advisors
  • [unknown], [unknown], Supervisor, External person
Award date2002 Apr 4
Publisher
ISBN (Print)91-628-5124-1
Publication statusPublished - 2002

Bibliographical note

Defence details

Date: 2002-04-04
Time: 09:15
Place: The Medical Research Centre (Jubileumsaulan), Malmö University Hospital

External reviewer(s)

Name: Zimmet, Paul
Title: Professor
Affiliation: M.D., Ph.D; International Diabetes Institute (Monash University), Victoria, Australia

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Article: Paper I.Tuomi T, Carlsson ÅL, Li H, Isomaa B, Miettinen A, Nilsson A, Nissen M, Ehrnstrom BO, Forsen B, Snickars B, Lahti K, Forsblom C, Saloranta C, Taskinen MR, Groop LC."Clinical and genetic characteristics of type 2 diabetes with and without GAD antibodies". Diabetes. 1999. 48:150-157.

Article: Paper II.Tripathy D, Carlsson ÅL, Lehto M, Tuomi T, Groop L."Insulin secretion and insulin sensitivity in diabetic subgroups: studies in the prediabetic and diabetic state".Diabetologia. 2000. 43:1476-1483

Article: Paper III.Carlsson ÅL, Sundkvist G, Groop L, Tuomi T. "Insulin and glucagon secretion in patients with slowly progressing autoimmune diabetes (LADA)".J Clin Endocrinol Metab. 2000. 85:76-80.

Article: Paper IV.Lethagen ÅL, Ericsson U-B, Hallengren B, Groop L, Tuomi T."GADab positivity is associated with impaired insulin response to glucose and arginine in nondiabetic patients with autoimmune thyroiditis"J Clin Endocrinol Metab. 2002. 87:1177-1183.

Article: Paper V.Lethagen ÅL, Groop L, Lindhom E,Tuomi T"Metabolic comparison of rapid and slow-onset autoimmune diabetes in newly-diagnosed patients over 35 years at onset".2002. Submitted manuscript (Diabetologia).

Subject classification (UKÄ)

  • Endocrinology and Diabetes

Free keywords

  • metabolic syndrome
  • insulin sensitivity
  • insulin secretion
  • GADabs
  • glutamic acid decarboxylase autoantibodies
  • Type 2 diabetes
  • LADA
  • Type 1 diabetes
  • IDDM1
  • IDDM2
  • Endocrinology
  • secreting systems
  • diabetology
  • Endokrinologi
  • sekretion
  • diabetologi

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