title: Frequency, immunogenetics, and clinical characteristics of latent autoimmune diabetes in China (LADA China study): a nationwide, multicenter, clinic-based cross-sectional study.
abstract: Adult non-insulin requiring diabetes includes latent autoimmune diabetes of adults (LADA), distinguished from type 2 diabetes by the presence of islet autoantibodies. LADA China determined the characteristics of Chinese LADA. This nationwide, multicenter, clinic-based cross-sectional study was conducted in 46 university-affiliated hospitals in 25 Chinese cities. All 4,880 ketosis-free diabetic patients (<1 year postdiagnosis, without insulin therapy for >6 months, aged ≥30 years) had GAD antibody (GADA) and HLA-DQ genotype measured centrally with clinical data collected locally. GADA-positive subjects were classified as LADA. Of the patients, 5.9% were GADA positive with LADA. LADA showed a north-south gradient. Compared with GADA-negative type 2 diabetes, LADA patients were leaner, with lower fasting C-peptide and less metabolic syndrome. Patients with high GADA titers are phenotypically different from those with low GADA titers, while only a higher HDL distinguished the latter from those with type 2 diabetes. HLA diabetes-susceptible haplotypes were more frequent in LADA, even in those with low-titer GADA. HLA diabetes-protective haplotypes were less frequent in LADA. Our study implicates universal immunogenetic effects, with some ethnic differences, in adult-onset autoimmune diabetes. Autoantibody positivity and titer could be important for LADA risk stratification and accurate therapeutic choice in clinical practice.
authors.affiliation: Diabetes Center, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital and Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China. zhouzg@hotmail.com
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Zhou
authors.forename: Yufei
authors.initials: Y
authors.lastname: Xiang
authors.forename: Linong
authors.initials: L
authors.lastname: Ji
authors.forename: Weiping
authors.initials: W
authors.lastname: Jia
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
authors.forename: Gan
authors.initials: G
authors.lastname: Huang
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.forename: Jian
authors.initials: J
authors.lastname: Lin
authors.forename: Zhenqi
authors.initials: Z
authors.lastname: Liu
authors.forename: William A
authors.initials: WA
authors.lastname: Hagopian
authors.forename: R David
authors.initials: RD
authors.lastname: Leslie
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000235:genetics / Q000276:immunology; D002096:C-Peptide / Q000097:blood; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D005260:Female; D020022:Genetic Predisposition to Disease; D005968:Glutamate Decarboxylase / Q000235:genetics / Q000276:immunology; D006683:HLA-DQ Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000276:immunology; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D012306:Risk
chemical_list: D001323:Autoantibodies; D002096:C-Peptide; D006683:HLA-DQ Antigens; D008075:Lipoproteins, HDL; D005968:Glutamate Decarboxylase