LADA and CARDS: a prospective study of clinical outcome in established
adult-onset autoimmune diabetes.
Author(s): Hawa MI(1), Buchan AP(1), Ola T(1), Wun CC(2), DeMicco DA(2), Bao W(2),
Betteridge DJ(3), Durrington PN(4), Fuller JH(5), Neil HA(6), Colhoun H(7),
Leslie RD(1), Hitman GA(8).
Affiliation(s): Author information:
(1)Centre for Diabetes, Barts and the London School of Medicine and Dentistry,
Queen Mary University of London, London, U.K. (2)Pfizer Inc., New York, NY.
(3)Department of Diabetes, University College London, London, U.K. (4)Department
of Medicine, University of Manchester, Manchester, U.K. (5)Department of
Epidemiology and Public Health, University College London, London, U.K. (6)Centre
for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.
(7)Medical Research Institute, University of Dundee, Dundee, U.K. (8)Centre for
Diabetes, Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, U.K. g.a.hitman@qmul.ac.uk.
Publication date & source: 2014, Diabetes Care. , 37(6):1643-9
OBJECTIVE: Diabetes-associated autoantibodies can be detected in adult-onset
diabetes, even when initially non-insulin requiring, i.e., with latent autoimmune
diabetes. We aimed to identify adult-onset autoimmune diabetes in patients with
established "type 2 diabetes" participating in the Collaborative Atorvastatin
Diabetes Study (CARDS) to characterize their phenotype and clinical outcome.
RESEARCH DESIGN AND METHODS: We prospectively studied 2,425 European patients
with presumed type 2 diabetes (mean age 62 years, diabetes duration 7.9 years)
for outcomes at 3.9 years after randomization to either atorvastatin or placebo.
Subjects were screened for autoantibodies to GAD (GADA), insulinoma-associated
antigen-2 (IA-2A), and zinc-transporter 8 (ZnT8A).
RESULTS: A total of 173 patients (7.1%) had GADA, of whom 11 (0.5%) and 5 (0.2%)
were also positive for IA-2A and ZnT8A, respectively. At baseline, 44% of
GADA-positive patients were not on insulin. Fewer autoantibody-positive than
autoantibody-negative patients had metabolic syndrome (64 vs. 80%), and more were
on insulin (56 vs. 17%) (P < 0.0001 for each) without lower HbA1c (69 mmol/mol
[8.5%] vs. 62 mmol/mol [7.8%]). The frequency of microvascular and macrovascular
events was similar in both cohorts, independent of atorvastatin.
CONCLUSIONS: Adult-onset autoimmune diabetes was prevalent, even in patients with
established diabetes presumed to have type 2 diabetes. After 11.8 years' diabetes
duration, nearly half the patients with autoimmune diabetes were not on insulin
treatment and almost two-thirds had metabolic syndrome. The type of diabetes,
whether autoimmune diabetes or type 2 diabetes, did not impact the risk of
microvascular disease.
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