Antibodies to GAD in Japanese patients classified as Type 2 diabetes at diagnosis. High titre of GAD Ab is a predictive marker for early insulin treatment--report of west Japan (Kyushu, Yamaguchi, Osaka) study for GAD Ab(+) diabetes.
OBJECTIVE
We evaluated the prevalence of GAD Ab in Japanese Type 2 diabetic patients treated with oral hypoglycaemic agents (OHA) and/or diet and followed GAD Ab(+) patients to assess the usefulness of GAD Ab as a marker for future insulin treatment prospectively.


METHODS
A total of 2658 Japanese Type 2 diabetic patients treated by OHA and/or diet were randomly selected between April 1996 and December 1998. The clinical characteristics at entry were assessed and patients were followed for 1-3 years.


RESULTS
The overall prevalence of GAD Ab among Type 2 diabetic patients was 2.0%. Forty-five had a history of diabetes of < or = 5 years (short history) while those with duration > 5 years (long history) totalled nine. Among them, 47% of patients with a short history did not require insulin in the follow-up period. However, none of those with a long history required insulin treatment within 2 years. Comparison of patients based on GAD titre in those with short history showed that 33% of patients in the high-titre group (> or = 20 U) required no insulin treatment in the first year of follow-up. In contrast, this proportion was 80% in the first and 67% in the second year in the low-titre group (< 20 U).


CONCLUSIONS
The prevalence of GAD Ab in Japanese patients with a short and long history of diabetes was 2.8% and 0.9%, respectively. The presence of GAD Ab in Japanese Type 2 diabetic patients with a short history of diabetes is a marker for early insulin treatment.
The First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. cea79120@hkg.odn.ne.jp
H
H
Takino
H
H
Yamasaki
N
N
Abiru
Y
Y
Sera
T
T
Abe
E
E
Kawasaki
Y
Y
Yamaguchi
K
K
Eguchi
Y
Y
Kanazawa
S
S
Nagataki
D000328:Adult; D017668:Age of Onset; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
D001323:Autoantibodies; D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin; D005968:Glutamate Decarboxylase