Chronic complications and mortality in community-based patients with latent autoimmune diabetes in adults: the Fremantle Diabetes Study.
OBJECTIVE
To compare (i) the prevalence and incidence of chronic complications and (ii) cardiac and all-cause mortality in community-based patients with latent autoimmune diabetes in adults (LADA) with those in Type 2 diabetic patients without antibodies to glutamic acid decarboxylase (GAD).


METHODS
Of the 1294 patients with clinically-defined Type 2 diabetes recruited to the longitudinal, observational Fremantle Diabetes Study between 1993 and 1996, 1255 (97%) had GAD antibodies measured at baseline. Complications were ascertained using standard criteria in patients returning for annual assessments until November 2001. Data on hospital admissions and mortality were available to the end of June 2006. Cox proportional hazards modelling was used to determine independent predictors of first occurrence of complications and cardiac and all-cause mortality.


RESULTS
Forty-five (3.6%) subjects had LADA. Compared with the GAD antibody-negative patients, they had a similar prevalence and incidence of coronary heart (P = 0.48 and 0.80, respectively) and cerebrovascular (P = 0.64 and 0.29) disease and cardiac and all-cause mortality (P = 0.62 and 0.81, respectively). There was also a similar prevalence and incidence of retinopathy (P = 0.22 and 0.64, respectively) and neuropathy (P = 0.25 and 0.95), but microalbuminuria was less frequent both at baseline and during follow-up in the LADA subgroup in unadjusted models (P = 0.046) and after adjustment for other risk factors (P = 0.014 and 0.013).


CONCLUSIONS
Except for a lower prevalence and incidence of nephropathy, LADA patients have a similar risk of complications and death to patients with clinically-diagnosed Type 2 diabetes without GAD antibodies. Cardiovascular risk factor management in LADA should, therefore, be as intensive as that for GAD antibody-negative patients.
Myhill
P
P
School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, WA, Australia.
Davis
W A
WA
Bruce
D G
DG
Mackay
I R
IR
Zimmet
P
P
Davis
T M E
TM
D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000401:mortality; D001323:Autoantibodies / Q000097:blood*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000201:enzymology / Q000276:immunology / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000201:enzymology / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality; D003930:Diabetic Retinopathy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006331:Heart Diseases / Q000150:complications / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D014739:Victoria
D001323:Autoantibodies; D005968:Glutamate Decarboxylase