title: Prevalence and clinical characteristics of insulin-treated, anti-GAD-positive, type 2 diabetic subjects in an outpatient clinical department of a Dutch teaching hospital.
abstract: BACKGROUND
  In clinical practice, type 1 and type 2 diabetic patients are sometimes difficult to distinguish. Type 1 diabetes has an immune-mediated pathogenesis, resulting in a loss of insulin-secreting beta-cells. Type 2 diabetes mellitus is characterised by a relative insulin insufficiency, without the presence of an autoimmune aetiology, initially due to insulin resistance and later also accompanied by defective insulin release. Latent autoimmune diabetes of the adult (LADA) is a subgroup of diabetes, somewhere on the borderland between type 1 and type 2 diabetes. LADA is characterised by a late-age onset and relatively mild progression, but with unmistakable signs of autoimmunity, such as the presence of the autoimmune antibodies anti-GAD65, anti-insulin antibodies, or anti-Ia-2ab.
  
  
  OBJECTIVE
  To establish the prevalence of anti-GAD ina diabetic outpatient clinic of a Dutch, non-university,teaching hospital and to describe these patients clinical and laboratory features, especially of the metabolic syndrome.
  
  
  METHODS
  We evaluated GAD65 antibodies and other parameters in 244 selected diabetic patients, who had been on oral therapy for at least three months before becoming insulin-dependent.
  
  
  RESULTS
  Twenty-six patients (11.6%) were positive for GAD65 antibodies. These patients had a significantly lower BMI (27.8 +/- 4.5 vs 31.1 +/- 4.9; p<0.01); less often cerebrovascular accidents (19.2 vs 34.9%; p<0.01) and a higher HDL cholesterol (1.73 +/- 0.53 vs 1.21 +/- 0.38; p<0.05). In contrast, anti-GAD patients had a significantly higher prevalence of hypothyroidism (23.0 vs 6.6%; p<0.05).
  
  
  CONCLUSIONS
  Anti-GAD-positive patients represent a sizable proportion of type 2 diabetes in a second-line outpatient clinic, and they are characterised by lower parameters of the metabolic syndrome, but higher prevalence of other autoimmune phenomena such as hypothyroidism.
authors.affiliation: Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: T E H
authors.initials: TE
authors.lastname: Römkens
authors.forename: G C M
authors.initials: GC
authors.lastname: Kusters
authors.forename: M G
authors.initials: MG
authors.lastname: Netea
authors.forename: P M
authors.initials: PM
authors.lastname: Netten
mesh_terms: D001323:Autoantibodies / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D005968:Glutamate Decarboxylase / Q000032:analysis / Q000276:immunology*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000276:immunology; D008875:Middle Aged; D009426:Netherlands; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D015995:Prevalence
chemical_list: D001323:Autoantibodies; D007328:Insulin; D005968:Glutamate Decarboxylase