title: Immune-mediated disease and secondary failure to oral therapy in type 2 diabetes mellitus.
abstract: OBJECTIVE
  To determine the proportion of adults with type 2 diabetes, who developed secondary failure to oral medications that had immune-mediated diabetes (IMD).
  
  
  METHODS
  One hundred and eight subjects who failed to oral therapy were screened for autoantibodies (ICA, IAA, IA-2A, and GADA(65)) and HLA DR/DQ markers of IMD.
  
  
  RESULTS
  Mean age was 49 years and mean body mass index (BMI) was 31.5 kg/m(2); 21.3% were non-Hispanic White (NHW), 32.3% Latin American (LA), and 43.2% African American (AA). Fourteen percent had one or more autoantibodies [Ab(+)]: five NHW, three LA, and seven AA. Ab(+) patients were younger (P=.03) and had lower body weight (P=.05) than Ab(-) patients. HLA markers of susceptibility for IMD were identified in 64% Ab(+) and in 43% Ab(-) (chi(2), P=.46).
  
  
  CONCLUSIONS
  These results suggest that secondary failure to oral therapy can be due to continuing IMD in obese, type 2 diabetic individuals of varying ethnic backgrounds than those who have been traditionally associated with autoimmune type 1 diabetes. Screening for markers for IMD at diagnosis could be a useful way to predict those likely to develop secondary failure to oral therapy and may assist in the selection of medical therapy.
authors.affiliation: Department of Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System 5323 Harry Hines Boulevard G5.238, Dallas, TX 75390-8858, USA. maines.aviles-santa@utsouthwestern.edu
authors.forename: Larissa
authors.initials: L
authors.lastname: Avilés-Santa
authors.forename: Noel
authors.initials: N
authors.lastname: Maclaren
authors.forename: Philip
authors.initials: P
authors.lastname: Raskin
mesh_terms: D000284:Administration, Oral; D001323:Autoantibodies / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006683:HLA-DQ Antigens / Q000097:blood; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D001323:Autoantibodies; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D007004:Hypoglycemic Agents