title: Heterogeneity of patients with latent autoimmune diabetes in adults: linkage to autoimmunity is apparent only in those with perceived need for insulin treatment: results from the Nord-Trøndelag Health (HUNT) study.
abstract: OBJECTIVE
  Subjects with the diagnosis of latent autoimmune diabetes in adults (LADA) are more prone to need insulin treatment than those with type 2 diabetes. However, not all patients with LADA develop the need for insulin treatment, indicating the heterogeneity of LADA. We investigated this heterogeneity by comparing phenotypes of LADA with and without perceived need for insulin treatment (data obtained at times when diagnosis of LADA was not investigated) and also compared LADA and type 2 diabetes phenotypes.
  
  
  METHODS
  We used data from the all population-based Nord-Trøndelag Health study (n = 64,931), performed in 1995-1997. Data were assembled for individuals with LADA (n = 106) and type 2 diabetes (n = 943).
  
  
  RESULTS
  In the comparison of individuals with LADA both with and without the need for insulin, insulin-treated subjects had higher titers of GAD antibodies (P < 0.001) and lower fasting C-peptide levels (P < 0.001). GAD antibodies and C-peptide correlated negatively (r = -0.40; P = 0.009). In the comparison of individuals with LADA and type 2 diabetes, all without the need for insulin, markers of metabolic syndrome were equally prevalent and pronounced. Age, C-peptide, and glucose levels were also similar. In the comparison of insulin-treated individuals with LADA and type 2 diabetes, more patients with LADA received insulin (40 vs. 22%, P < 0.001) and C-peptide levels were lower (P < 0.001). Patients with LADA were leaner but were still overweight (mean BMI 28.7 vs. 30.9 kg/m2 in type 2 diabetes, P < 0.001). In the comparison of type 2 diabetic patients with and without insulin, insulin-treated subjects were more obese and had higher A1C and lower C-peptide levels (P < 0.001).
  
  
  CONCLUSIONS
  Our conclusions are that 1) the need for insulin treatment in LADA is linked to the degree of autoimmunity and beta-cell failure, 2) subjects with LADA and type 2 diabetes without the need for insulin treatment are phenotypically similar, and 3) insulin treatment in type 2 diabetic patients is associated with both insulin resistance and beta-cell insufficiency.
authors.affiliation: Department of Cancer Research and Molecular Biology, Norwegian University of Science and Technology, Trondheim, Norway. maria.radtke@ntnu.no
authors.forename: Maria A
authors.initials: MA
authors.lastname: Radtke
authors.forename: Kristian
authors.initials: K
authors.lastname: Midthjell
authors.forename: Tom I Lund
authors.initials: TI
authors.lastname: Nilsen
authors.forename: Valdemar
authors.initials: V
authors.lastname: Grill
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000276:immunology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000523:psychology; D005968:Glutamate Decarboxylase / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000097:blood; D008875:Middle Aged; D009664:Norway; D010465:Perception; D010641:Phenotype; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D005968:Glutamate Decarboxylase