Frequency, Immunogenetics, and Clinical Characteristics of Latent Autoimmune Diabetes in China (LADA China Study)
A Nationwide, Multicenter, Clinic-Based Cross-Sectional Study
- Zhiguang Zhou1⇓,
- Yufei Xiang1,
- Linong Ji2,
- Weiping Jia3,
- Guang Ning4,
- Gan Huang1,
- Lin Yang1,
- Jian Lin1,
- Zhenqi Liu5,
- William A. Hagopian6,
- R. David Leslie7,
- on behalf of the LADA China Study Group*
- 1Diabetes Center, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital and Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China
- 2Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- 3Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- 4Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Ruijin Hospital, Shanghai, China
- 5Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia
- 6Pacific Northwest Diabetes Research Institute, Seattle, Washington
- 7Department of Diabetes and Metabolic Medicine, Blizard Institute, London, U.K.
- Corresponding author: Zhiguang Zhou, .
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.
- Received February 20, 2012.
- Accepted July 25, 2012.
- © 2013 by the American Diabetes Association.
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