Relation between disease phenotype and HLA-DQ genotype in diabetic patients diagnosed in early adulthood.
We investigated inaugural disease phenotype in relation to the presence or absence of diabetes-associated autoantibodies and human leukocyte antigen (HLA) DQ risk genotypes in adult-onset diabetic patients. Blood samples and questionnaires were obtained from 1584 recent-onset Belgian Caucasian patients (age 15-39 yr at diagnosis of primary diabetes) who were recruited by the Belgian Diabetes Registry over an 11-yr period. At clinical diagnosis, antibody-positive patients (n = 1198) were on average younger and had more symptoms, a more acute disease onset, lower body mass index, and random C-peptide levels, but higher insulin needs, glycemia, and prevalence of ketonuria, HLA-DQ, and 5' insulin gene susceptibility genotypes (P < 0.001 vs. antibody-negative patients; n = 386). In antibody-positive patients, these characteristics did not differ according to HLA-DQ genotype. However, in antibody-negative subjects, we found that patients were younger (P = 0.001); had a lower body mass index (P < 0.001), higher insulin needs (P = 0.014), and amylasemia (P = 0.001); and tended to have a higher glycemia and lower C-peptide in the presence of susceptible HLA-DQ genotypes. Differences according to HLA-DQ genotype subsisted after careful age-matching. In conclusion, we found no relation between initial disease phenotype and HLA-DQ genotype in antibody-positive diabetic young adults. In contrast, antibody-negative patients displayed more type 1-like features when carrying susceptible HLA-DQ genotypes known to promote the development of antibody-positive diabetes. The overrepresentation of these susceptibility genotypes in antibody-negative patients suggests the existence of an immune-mediated disease process with as yet unidentified immune markers in a subgroup of seronegative patients.
Weets
Ilse
I
Diabetes Research Center, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
Siraux
Valerie
V
Daubresse
Jean-Claude
JC
De Leeuw
Ivo H
IH
Féry
Francoise
F
Keymeulen
Bart
B
Krzentowski
Georges
G
Letiexhe
Michel
M
Mathieu
Chantal
C
Nobels
Frank
F
Rottiers
Raoul
R
Scheen
André
A
Van Gaal
Luc
L
Schuit
Frans C
FC
Van der Auwera
Bart
B
Rui
Mao
M
De Pauw
Pieter
P
Kaufman
Leonard
L
Gorus
Frans K
FK
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D003920:Diabetes Mellitus / Q000235:genetics* / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D005838:Genotype; D006683:HLA-DQ Antigens / Q000235:genetics*; D006801:Humans; D008297:Male; D010641:Phenotype
D001323:Autoantibodies; D006683:HLA-DQ Antigens