LADA prevalence estimation and insulin dependency during follow-up

• Published in: Diabetes/metabolism research and reviews 2011-11, Vol.27 (8), p.975-979
• Main Authors: Park, Yongsoo, Hong, Sangmo, Park, Leejin, Woo, Jungtaek, Baik, Sehyun, Nam, Munsuk, Lee, Kwanwoo, Kim, Youngseol
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asian Continental Ancestry Group - statistics & numerical data; Autoantibodies - analysis; Cation Transport Proteins - immunology; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - immunology; Disease Progression; Female; Follow-Up Studies; Glutamate Decarboxylase - immunology; Humans; incidence; Insulin - therapeutic use; insulin dependency; Insulin Resistance; Korea - epidemiology; LADA; Male; Middle Aged; multiple autoantibody positivity; Prevalence; Prospective Studies; Zinc Transporter 8
• ISSN: 1520-7552; 1520-7560
• DOI: 10.1002/dmrr.1278

Background Latent autoimmune diabetes in adults (LADA) is a form of autoimmune‐mediated diabetes in adults, usually defined by GAD autoantibody positivity. Few epidemiological surveys on LADA in Asians did not come to a conclusive answer regarding prevalence and incidence, because of different criteria used in patient ascertainment. Methods We estimated LADA prevalence in a recent type 2 diabetes cohort by the positivity of circulating autoantibodies to pancreatic islet cell antigens (GAD, IA‐2 and zinc transporter 8 (ZnT8)) applying a comparable Caucasian criteria. We then observed the development of insulin dependency prospectively for 36 months. Results Applying the European NIRAD LADA group criteria, we found a high prevalence of LADA (4.4%) in Korean patients with phenotypic type 2 diabetes. This high prevalence of LADA in Korea is noteworthy since the previous population‐based LADA prevalence survey reported low prevalence (1.7%). When we consider the low‐titre GAD antibodies and the low prevalence of multiple autoantibodies, however, increased LADA prevalence does not necessarily mean increase in future insulin dependency. After 36 months of follow‐up, only 3 of 39 patients who were initially classified as LADA have become insulin‐dependent. Those three were all positive for multiple autoantibodies (GAD, IA‐2 and zinc transporter 8 antibody). Other features of insulin secretion or insulin resistance did not determine future insulin necessity. Conclusions Although the LADA prevalence estimated by anti‐GAD positivity appeared to increase, the true insulin dependency evidenced by multiple antibody positivity did not increase in Korea. Copyright © 2011 John Wiley & Sons, Ltd.